supporting document schedules · 2019-07-26 · b. cover letter & pa bulletin information x c....

Supporting Document Schedules Satisfied - Item: ACA Public Rate Filing PDFComments:Attachment(s): 2020_PA_Health_and_Wellness_Inc_Public_Rate_Filing_PDF_20190719.pdfItem Status:Status Date:

SERFF Tracking #: CECO-131936143 State Tracking #: CECO-131936143 Company Tracking #: RATES - 86199

State: Pennsylvania Filing Company: Pennsylvania Health & Wellness, Inc.

TOI/Sub-TOI: H15I Individual Health - Hospital/Surgical/Medical Expense/H15I.001 Health - Hospital/Surgical/Medical Expense

Product Name: Ambetter from PA Health & Wellness

Project Name/Number: /

PDF Pipeline for SERFF Tracking Number CECO-131936143 Generated 07/22/2019 07:27 AM

May 13, 2019 Pennsylvania Insurance Department 1311 Strawberry Square Harrisburg, PA 17120 Re: Actuarial Memorandum – Pennsylvania – Pennsylvania Health & Wellness, Inc. – Individual Rate Filing, Effective January 1, 2020 Ms. Gray, This filing includes Pennsylvania Health & Wellness, Inc. (PHW)’s Individual Market rates and supporting documentation for rates effective January 1, 2020. Below you may find the requested company information, in response to the guidance sent to PHW on April 3, 2019. Requested Company Information 1. Company Name & NAIC number: Pennsylvania Health & Wellness, Inc.; NAIC # 16041

2. Market (Individual or Small Group): Individual

3. On or Off Exchange: On Exchange

4. Effective date of coverage: January 1, 2020

5. Average rate change requested: -1.5%

6. Range of rate change requested: -5.0% to 0.4%

7. Total additional annual revenue generated from the proposed rate change: -$201,039

8. Product(s) (Indemnity, HMO, POS (HMOs only), PPO, or EPO): HMO

9. Rating Areas and any changes from 2019: Rating Area 8 (no changes from 2019)

10. Metal Levels and Catastrophic Plans: Gold, Silver, Bronze

11. Current number of covered lives and of policyholders as of February 1, 2019 as shown in

Cell V15 of Table 10: Covered lives - 1,869; Policyholders - 1,547

12. Number of plans offered in 2020 and the change this represents from 2019: There are 18 plans offered in 2020. There were 5 plans offered in 2019.

13. Corresponding contract form number, SERFF and Binder ID numbers: FORM: CECO-

131936155; SERFF: CECO-131936143; Binder: CECO-PA20-125092615

14. HIOS Issuer ID number and submission tracking number: HIOS Issuer ID number:86199; Submission tracking number: 86199-1488942398695937039

June 24, 2019 Pennsylvania Insurance Department 1311 Strawberry Square Harrisburg, PA 17120 Re: Actuarial Memorandum – Pennsylvania – Pennsylvania Health & Wellness, Inc. – Individual Rate Filing, Effective January 1, 2020 Ms. Gray, This filing includes Pennsylvania Health & Wellness, Inc. (PHW)’s Individual Market rates and supporting documentation for rates effective January 1, 2020. Below you may find the requested company information, in response to the guidance sent to PHW on April 3, 2019. Requested Company Information 1. Company Name & NAIC number: Pennsylvania Health & Wellness, Inc.; NAIC # 16041

2. Market (Individual or Small Group): Individual

3. On or Off Exchange: On Exchange

4. Effective date of coverage: January 1, 2020

5. Average rate change requested: -1.36%

6. Range of rate change requested: -5.09% to 0.40%

7. Total additional annual revenue generated from the proposed rate change: -$201,039

8. Product(s) (Indemnity, HMO, POS (HMOs only), PPO, or EPO): HMO

9. Rating Areas and any changes from 2019: Rating Area 8 (no changes from 2019)

10. Metal Levels and Catastrophic Plans: Gold, Silver, Bronze

11. Current number of covered lives and of policyholders as of February 1, 2019 as shown in

Cell V15 of Table 10: Covered lives - 1,869; Policyholders - 1,547

12. Number of plans offered in 2020 and the change this represents from 2019: There are 18 plans offered in 2020. There were 5 plans offered in 2019.

13. Corresponding contract form number, SERFF and Binder ID numbers: FORM: CECO-

131936155; SERFF: CECO-131936143; Binder: CECO-PA20-125092615

14. HIOS Issuer ID number and submission tracking number: HIOS Issuer ID number:86199; Submission tracking number: 86199-1488942398695937039

Rate Change Summary

Pennsylvania Health & Wellness, Inc. – Individual Plans

Rate request filing ID # CECO-131936143 - This document is prepared by the insurance

company submitting the rate filing as a consumer tool to help explain the rate filing. It is not

intended to describe or include all factors or information considered in the review process. For

more information, see the filing at

http://www.insurance.pa.gov/Consumers/ACARelatedFilings/

Overview Initial requested average rate change: -1.36%1

Revised requested average rate change: -N/A1

Range of requested rate change: -5.09% to 0.40%

Effective date: January 1, 2020

People impacted: 1,869

Available in: Rating Area 8

Key information

Jan. 2018-Dec. 2018 financial experience

Premiums $N/A

Claims $N/A

Administrative expenses $N/A

Taxes & fees $N/A

Company made (after taxes) $N/A

The company expects its annual medical costs to increase 9.49%.

Explanation of requested rate change

Factors such as cost of care, taxes, utilization of health services, proposed changes in benefits, and

anticipated changes in morbidity in relation to the single risk pool, all contribute to the 2020 rate

change.

1 Note that insurers will have the opportunity to revise their rate change request in July, after they are scheduled to receive

updated information about the impact of a federal program called risk adjustment. This document will be updated accordingly

at that time.

How it plans to spend your premium

This is how the insurance company plans to

spend the premium it collects in 2020:

Claims: 87.16%

Administrative: 7.86%

Taxes & fees: 3.23%

Profit: 1.75%

Completeness and Redaction Justification Checklist

Redacted(Y/N)

Page # inPublic PDF

Justification submitted(Y/NA)

RFJ Part I - Unified Rate Review Template XRFJ Part II – Consumer Friendly Justification X

RFJ Part III – Actuarial Memorandum X Y

50; 63-65;77-78; 80;

91; 101; 107;115

Y

Federal Rates Template X

A.2.B. HIOS Submission XA.2.C. SERFF Submission XA.2.D. SERFF Rate/Rule Schedule Tab XB. Cover Letter & PA Bulletin Information XC. Rate Change Request Summary X

D.1.A. Company Information X ND.1.B. Rate History & Proposed Variation in Rate Changes X ND.1.C. Average Rate Change X N

Membership Count X N PA Act. Exhibits Table 1 X N

D.1.E. Benefit Changes X NExperience Period Claims & Premium X N PA Act. Exhibits Table 2 X NCredibility of Data X N PA Act. Exhibits Tables 2b, 3b, 4b (if applicable) X NTrend Identification X N PA Act. Exhibits Table 3 X NHistorical Experience X N PA Act. Exhibits Table 4 X NDevelopment of PAIR, MAIR and Total Allowed Claims X Y 12-14 Y PA Act. Exhibits Table 5 X NRetention Items X Y 18 Y PA Act. Exhibits Table 6 X NNormalized Market-Adjusted Projected Allowed Total Claims X N PA Act. Exhibits Table 7 X NComponents of Rate Change X N PA Act. Exhibits Table 8 X N PA Act. Exhibits Table 9 X NPlan Rate Development X N PA Act. Exhibits Table 10 X NPlan Premium Development for 21-Year-Old Non-Tobacco User X N PA Act. Exhibits Table 11 X NAge and Tobacco Factors X N PA Act. Exhibits Table 12 X NGeographic Factors X N PA Act. Exhibits Table 13 X NNetwork Factors X N PA Act. Exhibits Table 14 X N

D.5.D. Service Area Composition X ND.5.E. Composite Rating X ND.6. Actuarial Certifications X Y 23; 25 Y

Department Plan Design Summary & Rate Tables X NService Area Map X N

X Y

D.1.H.

D.1.I.

D.2.A.

D.2.B.

D.1.F.

Issuer Name: Pennsylvania Health & Wellness, Inc.Market: Individual

Redaction JustificationCompleted

(Mark with "X")TOC # Description

Redaction Justification (must be submitted if any information is redacted)

PA Actuarial Memorandum and Rate Exhibits

Federal Documents Required to Be Filed with PID

Summary Documents/Confirmation of HIOS & SERFF Submissions

Additional Exhibits

D.1.D.

D.5.B.

D.5.C.

A.2.

E.

D.2.C.

D.2.D.

D.3.

D.4.

D.5.A.

D.1.G.

SERFF ID: CECO-131936143

REDACTION JUSTIFICATION

The following is a list of items that will be redacted from Pennsylvania Health and Wellness, Inc.’s rate filing, in accordance with the 2020 ACA-Compliant Health Insurance Rate Filing Guidance, released by the Pennsylvania Insurance Department on April 3, 2019.

Pennsylvania Actuarial Memorandum

• Projected Risk Adjustment Transfers (pages 12, 14) [Statements specifying a company’s anticipated risk level in relation to the state average risk level]

• State average premium assumption (page 13) [Statements specifying a company’s anticipated risk level in relation to the state average risk level]

• Information on broker commissions (page 18) [Commission schedules] • Name of opining actuary (pages 23, 25) [Opining actuary’s name]

Part III – Federal Actuarial Memorandum

• Company Contact Information (pages 50, 77, 115) [Opining actuary’s name] o Name, Telephone Number, and Email Address

• Projected Risk Adjustment Transfers (pages 63, 65, 91) [Statements specifying a company’s anticipated risk level in relation to the state average risk level]

• State average premium assumption (page 64) [Statements specifying a company’s anticipated risk level in relation to the state average risk level]

• Name of opining actuary (pages 78, 80) [Opining actuary’s name] • AV Calculator Screenshots (page 101) [AV Screenshots] • Sample Producer Agreement (page 107) [Specific provider contracting

information]

Objection Response sent 6/24/2019

• Relative Morbidity (page 129) [Statements specifying a company’s anticipated risk level in relation to the state average risk level]

• Average Commission (page 134) [Commission schedules]

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Pennsylvania Actuarial Memorandum

[Redacted]

Pennsylvania Health and Wellness, Inc.

Annual Individual Health Rate Filing

Effective January 1, 2020

Forms: 86199PA001, 86199PA002

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TABLE OF CONTENTS

1. BASIC INFORMATION AND DATA ............................................................................................................ 3

2. RATE DEVELOPMENT AND CHANGE ...................................................................................................... 7

3. PLAN RATE DEVELOPMENT .................................................................................................................. 16

4. PLAN PREMIUM DEVELOPMENT FOR 21-YEAR OLD NON-TOBACCO USER ..................................... 17

5. PLAN FACTORS ...................................................................................................................................... 18

6. ACTUARIAL CERTIFICATION ................................................................................................................. 19

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1. Basic Information and Data

a. Company Information

Please see Table 0, “Identifying Information” for the requested company identifyinginformation.

b. Rate History and Proposed Variation in Rate Changes

The rate projections for 2020 have been updated from the previous year’s projections toreflect the most recent information available.

The following provides a narrative description of the significant factors driving theproposed rate change for 2020. Appendix 2.1 provides quantitative support for theproposed rate changes.

· Unit Cost trend

Expected unit cost levels and reimbursement arrangements with providers havechanged between 2019 and 2020.

· Utilization trend

The Milliman Health Cost Guidelines underlying the rate projections have beenupdated. The current model reflects the projected utilization trend from 2019 to2020.

· Prospective changes to benefits covered by the product or successor products

The benefits covered are not expected to change between 2019 and 2020 planyears.

· Taxes and fees imposed on the issuer

Premium rates have been adjusted to reflect the schedule of taxes and fees for2020. For 2019, there was a moratorium on the ACA Insurer Fee. Thismoratorium is not slated to continue into 2020. This increases rates relative to2019.

· Anticipated changes in the average morbidity of the single risk pool

The 2020 projection of morbidity reflects a restatement of the 2019 enrollmentand morbidity projection based on emerging information plus the projectedimpact of new enrollment into the risk pool from 2019 to 2020 on the risk pool.

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· Non-funding of cost-sharing reduction (CSR) subsidies

Premium rates continue to reflect that PHW will not be reimbursed by the U.S.Department of Health and Human Services (HHS) for cost-sharing on CSR Silverplans. Enrollment projections reflect updated expectations regarding memberplan selections by metal and CSR level, which in turn affect the required rateload to compensate for CSR non-funding.

The variance in the rate changes across plans does not reflect the incorporationof plan-specific morbidity. When projecting plan rating factors, we have assumedthe same demographic and risk characteristics for each plan priced. This pricingmethod excludes expected differences in the morbidity of members assumed toselect the plan.

c. Average Rate Change

Please see Table 10, “Plan Rates” for the average rate change. Please also see Table11, “Plan Premium Development for 21-Year-Old Non-Tobacco User” for the change in21-year-old non-tobacco premium PMPM.

d. Membership Count

Please see Table 1, “Number of Members” for the average age, age breakdown, andtotal number of members for the projection period.

e. Benefit Changes

Please see Appendix 20.5 for details on benefit changes.

f. Experience Period Claims and Premiums

PHW does not have 2018 experience, as it was first offered in 2019. Table 2,“Experience Period Claims and Premiums” has been intentionally left blank.

g. Credibility of Data

PHW does not have 2018 experience, as it was first offered in 2019. The rates in thefiling are fully based on manual data.

Manual Experience Basis

The manual rate development is based on the Milliman Managed Care Rating Model(MCRM) and the companion Milliman Health Cost Guidelines (HCGs), and

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consideration of relevant QHP experience in other states. The MCRM includes severaladjustments from the HCGs to be consistent with and appropriate for the expectedindividual population that will be enrolled, including morbidity, geographic area utilizationrelativities, expected provider reimbursement, and utilization management programs.

The HCGs provide a flexible but consistent basis for the determination of claim costs fora wide variety of health benefit plans. These rating structures are used to anticipatefuture claim levels, evaluate past experience, and establish interrelationships betweendifferent health coverage levels.

The Milliman HCGs are developed as a result of Milliman’s continuing research onhealth care costs. They were first developed in 1954 and have been updated andexpanded annually since then. These guidelines are continually monitored as we usethem in measuring the experience or evaluating the rates of our clients and as wecompare them to other data sources.

The HCGs are a cooperative effort of all Milliman health actuaries and represent acombination of their experience, research, and judgment. An extensive amount of datais used in developing these guidelines including published and unpublished data. Inmost instances, cost assumptions are based on our evaluation of several data sourcesand, therefore, are not specifically attributable to a single source. Since these guidelinesare a proprietary document of Milliman, they are only available for release to specificclients that lease these guidelines and to Milliman consulting health actuaries.

Market-wide rates were developed based on the adjusted MCRM (see “AdjustmentsMade to the Data” below for more detail on these adjustments). We used the HCGs toestimate the value of cost-sharing and relative utilization of services for each plan andto inform rating factors.

Manual Morbidity Basis

Composite morbidity factors are used to adjust the Milliman Managed Care RatingModel (MCRM) from the large employer group basis of the HCGs to the projectedmorbidity of PHW’s membership in 2020.

The morbidity for PHW's 2020 membership is assumed to equal the projected morbidityfor the Pennsylvania single risk pool times the morbidity of PHW's membership relativeto the single risk pool.

We estimated historical single risk pool morbidity by comparing historical riskadjustment results for the Pennsylvania individual market versus the employer grouppopulation underlying the HCGs, controlling for risk score differences attributable tonon-morbidity factors (e.g. demographics and plan mix). We then projected thishistorical morbidity snapshot forward to account for expected changes in the risk poolcomposition over time

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The relative morbidity assumption used for projecting claims reflects PHW’sexpectations regarding the morbidity of its 2020 membership relative to the single riskpool, and is consistent with the relative morbidity assumption used to estimate PHW’srisk transfer payment/receivable.

Adjustments Made to the Data

The following adjustments were made to calibrate the pricing model to the expectedpopulation:

- Expected demographics- Expected morbidity- Cost trend and provider reimbursement- Expected utilization management savings- Utilization trend- Consideration of relevant QHP experience- Benefit plan designs and expected cost-sharing

See Appendix 8.1 for a demonstration of these adjustments. The adjustments, whichare discussed above, are appropriate and necessary to reflect the anticipatedpopulation, region, provider network, and benefits anticipated for the 2020 single riskpool.

h. Trend Identification

This filing is fully based on manual data, and thus has no experience to trend forward.Table 3 “Trend Components” has been intentionally left blank.

i. Historical Experience

PHW does not have 2018 experience, as it was first offered in 2019. Table 4, “HistoricalExperience” has been intentionally left blank.

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2. Rate Development and Change

a. Development of Projected Index Rate, Market-Adjusted Index Rate, and TotalAllowed Claims

Please see Table 5 for the development of the Projected Index Rate, Market-AdjustedIndex Rate, and Total Allowed Claims.

Projected Index Rate

PHW did not offer products in 2018, so the Index Rate for the Experience Period doesnot apply.

The Index Rate for the Projection Period ($537.19) (calendar year 2020) is reflected inWorksheet 1, Section II of the URRT. It was developed following the specifications of 45CFR part 156.80(d)(1). The Index Rate for the Projection Period represents theestimated total combined projected allowed claims PMPM for EHBs for calendar year2020 and has not been adjusted for payments and charges under the risk adjustmentprogram or for Exchange user fees. The total allowed claims include benefits in excessof EHBs (coverage for adult vision and adult dental). Pediatric dental is excluded in thebenefit package since this will be offered through a stand-alone plan on the Exchange.The Index Rate for the Projection Period was calculated based on the methodologydiscussed in above and does not include benefits in excess of the EHBs. The IndexRate for the Projection Period will remain unchanged until a renewal filing effectiveJanuary 1, 2021.

The development of the Index Rate for the Projection Period is shown in Worksheet 1,Section II. This reflects:

· The projection period of calendar year 2020

· The anticipated claim level of the projection period with respect to trend, benefits,and demographics

· The experience of all policies expected to be in the single risk pool (withnecessary adjustments)

Appendix 10.1 demonstrates the calculation of the Projected Index Rate byblending the Experience Period Index Rate with the Credibility Manual IndexRate, as applicable. The next two sections further describe the steps taken todevelop the Market-wide Adjusted Index Rate and Plan Adjusted Index Rates.

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Market-Adjusted Index Rate

The Index Rate for the Projection Period is adjusted to arrive at the Market-wideAdjusted Index Rate ($625.19) based on the following two adjustments, as outlined in45 CFR 156.80(d)(1):

· Adjustment for the Risk Adjustment Program

· Exchange user fee adjustment

Since the Index Rate is on an allowed claims basis, the market-level adjustments areapplied on an allowed basis. Similar to the Index Rate, the Market-wide Adjusted IndexRate reflects the average demographic characteristics of the single risk pool. TheMarket-wide Adjusted Index Rate is not calibrated. Appendix 11.1 shows thedevelopment of the Market-wide Adjusted Index Rate.

Reinsurance

No state or federal reinsurance recoveries are expected in the projection period. Assuch, no reinsurance was entered in the field for projected reinsurance on URRTWorksheet 1, Section II.

Risk Adjustment Payment/Charge

The Projected Risk Adjustment Transfer PMPM '''''''''''''''''''''''' is shown on Worksheet 1,Section II. This amount does not include the 2020 Risk Adjustment User Fee of $0.18PMPM (0.03% of premium). The Risk Adjustment User Fee is included with Taxes andFees on Worksheet 2, Field #3.7 Appendix 11.1 shows how the anticipated riskadjustment transfer revenue is applied to the Index Rate in the development of theMarket-wide Adjusted Index Rate.

The state transfer calculation portion of the total risk adjustment transfer is based on therisk adjustment transfer formula, as provided in the Federal Register Volume 78Number 47, and displayed below.

= × ×∑ ( × × × ) −

× × ×∑ ( × × × × )

Where:

s = state average premium;

PLRSi = plan i’s plan liability risk score;

AVi = plan i’s metal level AV;

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ARFi = plan i‘s allowable rating factor;

IDFi = plan i’s induced demand factor;

GCFi = plan i’s geographic cost factor;

si = plan i’s share of state enrollment as measured in member months;

and the denominator is summed across all plans in the risk pool in the market in thestate.

We project the portfolio average for each factor in the risk adjustment transfer formulausing a combination of (i) the state’s actual historical risk adjustment factors adjusted tothe projected population and (ii) adjustments for market and risk adjustment programchanges. The resulting aggregate payment or receivable is then proportionally allocatedto all plans in the portfolio.

For the purpose of our modeling, each of these factors was approximated as follows.

P: The state average premium was assumed to be approximately '''''''''''' ''''''''''''''' (net ofthe 14% administrative cost carve out).

PLRS: The statewide average risk score is projected based on the average PLRS of thesingle risk pool in 2017, as reported by the U.S. Department of Health and HumanServices (HHS), adjusted for projected changes in the demographics, morbidity, andplan mix of the single risk pool from 2017 to 2020.

The average risk score for PHW’s membership is projected by adjusting the projectedsingle risk pool average risk score for risk score differences associated withdemographic, plan mix, and morbidity differences between the two populations.

HHS’s proposed HCC model and coefficient changes for 2019 and 2020 wereconsidered in the development of the projected risk adjustment transfer. Thedemographic, plan mix, and morbidity assumptions supporting the projected statewideand PHW risk score projections are consistent with the demographic, plan mix, andmorbidity assumptions used to project claims costs.

IDF: The statewide average IDF is projected based on the average IDF of the single riskpool in 2017, as reported by HHS.

The average IDF for PHW is projected by applying the induced demand factors from themarket reform rule published in the March 11, 2013 Federal Register, page 15433,Table 11 to PHW’s projected population. The formula recognizes the following IDFfactors by metallic tier: Bronze 1.00, Silver 1.03, Gold 1.08 and Platinum 1.15.

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AV: The statewide average actuarial value (AV) is projected based on the averagemetal level AV of the single risk pool in 2017, as reported by HHS.

The average AV for PHW is projected by applying the metal level AV factors from themarket reform rule published in the March 11, 2013 Federal Register, page 15433,Table 9 to PHW’s projected population. The formula recognizes the following AV valuesby metallic tier: Bronze 0.60, Silver 0.70, Gold 0.80, and Platinum 0.90.

ARF: As stated in the March 11, 2013 Federal Register, page 15433, the allowablerating factor (ARF) adjustment accounts only for age rating.

The statewide average ARF is projected based on the average ARF of the single riskpool in 2017, as reported by HHS, adjusted for projected changes in the demographicsof the single risk pool from 2017 to 2020.

The average ARF for PHW is projected by applying the proposed 2020 HHS age ratingfactors to PHW’s projected population. An equal distribution across ages within eachage band was assumed.

GCF: The average GCF for PHW relative to the statewide average was modeled basedon historical GCFs by rating area, any anticipated changes in these GCFs over time,and PHW’s projected enrollment by rating area.

The total transfer is calculated as the sum of the state transfer calculation describedabove and a net transfer for 2020 attributable to the high cost risk pooling program. Wemodeled this as the combination of a receivable, based on the attachment point andcoinsurance from the 2020 Notice of Benefit and Payment Parameters (NBPP), and anassessment, based as a percentage of premium.

Outliers were reflected in our calculations to the extent that outliers are reflected inhistorical risk scores used as the starting point of the 2020 risk transfer projection andvia the calculation of the net high cost risk pooling receivable or payment. Otherwise,there were no “potential outlier assumptions” that would have an impact on transfers.

The projected transfer amount assumes no impact under the Risk Adjustment DataValidation (RADV) process.

The risk adjustment transfer amounts '''''''''''''''''''''' shown on Worksheet 1 of the URRT arethe actual PMPM amounts expected in the projection period. The risk adjustmenttransfer amount applied to the Index Rate in the development of the Market AdjustedIndex Rate is on an allowed claims basis, as the Index Rate is on an allowed claimsbasis.

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The demographic, plan mix, and morbidity assumptions supporting the risk transferprojection are consistent with the demographic, plan mix, and morbidity assumptionsused to project claims costs.

Exchange User Fees

The Exchange user fee adjustment applied to premium rates is 3.00% of premium. Thisis based on weighting the expected distribution of issuer enrollment sold through theExchange and sold outside of the Exchange. Per the 2020 final benefit and paymentparameters, the Exchange user fee is 3.00% of premium for members purchasingcoverage via the Exchange, and there is no Exchange fee for members enrolling incoverage outside of the Exchange. We assumed 100% of members would enrollthrough the Exchange and 0% would enroll outside of the Exchange. On Appendix 11.1,the user fee is shown on an allowed basis as a multiplicative factor, and this factor is1.036.

Plan-Adjusted Index Rate

The Plan Adjusted Index Rates (average Plan Adjusted Index Rate: $590.41) areincluded in Worksheet 2, Section III of the URRT. The Plan Adjusted Index Rates arethe Market-wide Adjusted Index Rate adjusted for only the following allowableadjustments, where applicable, as outlined in 45 CFR 156.80(d)(2):

· The actuarial value and cost-sharing design of the plan

o The CMS Actuarial Value Calculator was used to determine the AV metalvalue for each plan.

o The actuarial value and cost-sharing pricing adjustment was developedusing a combination of the Milliman Managed Care Rating Model(MCRM), calibrated to the expected population, paired with a claimssimulation methodology.

§ Relativities between plans were developed using a 50/50 blend of aclaims simulation method and the 2019 manual plan rating factors.The approach balances the results of multiple methodologies andpromotes market stability.

§ Under a claims simulation approach to modeling plan relativities,member-level claims are re-adjudicated using the cost sharingparameters of each plan design, thereby calculating plan versuspatient liability.

§ The claims simulation model used here is based on a nationwide,claim-level dataset of Individual exchange members. Using this

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dataset for plan rating factors ensures that a static demographicand risk profile informs the rating factor of each plan, therebyexcluding any differences in the morbidity of members assumed toselect the plan.

§ The national dataset was calibrated to 2020 projected allowedcosts to ensure that member cost shares are applied to theappropriate cost level. Allowed relativities by plan reflect utilizationdifferences originating from benefit richness, based on the MillimanHealth Cost Guidelines. Relying on a manual model for theseinduced utilization differences precludes the reflection of morbidity.

§ Rate increases can vary by plan under this methodology withoutreflecting morbidity differences. For example, rate increasesnaturally vary by plan over time as the relationship changesbetween cost sharing levels and the allowed costs to which theyare applied (i.e., leveraging).

o The actuarial and cost-sharing pricing adjustment reflects full plan liabilityfor CSR subsidies. CSR costs are reflected as a uniform percentage loadapplied to each silver ACA-compliant plan (both those sold through theExchange and those sold outside of the Exchange).

· The plan’s provider network, delivery system characteristics, and utilizationmanagement adjustment practices.

o Not applicable. All plans have the same provider network.

· Benefits provided under the plan that are in addition to the EHBs.

o For a subset of plans, additional benefits include coverage for adult visionand adult dental.

· Administrative costs, excluding the Exchange user fees (which are alreadyaccounted for in the Market-wide Adjusted Index Rate).

o Non-benefit expenses ($46.51) are discussed in detail below.

There are no catastrophic plans being offered, so there is no eligibility adjustment madefor catastrophic plan enrollment.

Administrative costs and other benefits (non-EHB) common to all plans are added to theMarket-wide Adjusted Index Rate. Then, factors for actuarial value and cost-sharing andnon-EHBs by plan are applied to reach the Plan Adjusted Index Rate for each plan.

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The development and values of the Plan Adjusted Index Rates are shown in Appendix12.1.

The Plan Adjusted Index Rates reflect the average demographic characteristics of thesingle risk pool and are not calibrated.

The Plan Adjusted Index Rates of the Experience Period are set to zero as there is noreported experience on Worksheet 2, Section II of the URRT.

Total Allowed Claims

Section 1g describes the process for how the Projected Total Allowed Claims weredeveloped.

Inclusion of Capitation Payments

Capitated payments for services are accounted for through a PMPM allocation toclaims, where the average capitation amount replaces the projected claims amount.

In 2020, children will be capitated at $5.22 PMPM for Envolve Vision (Exam &Hardware, Medical & Surgical), Envolve People Care (Health Coaching and NurseLine),Startsmart, and Teledoc – Telehealth. Adults on the base product will be capitated at$2.36 PMPM. Adults are lower since Envolve Vision (Exam & Hardware) is not includedin the base product. Adults with the Vision+Dental buy-up will be capitated an additional$24.19 PMPM for Envolve Vision (Exam & Hardware) and Envolve Dental. The datesfor the contract are CY2020.

b. Retention Items

Please see Table 6, “Retention”, for the retention items. Combined with margin andcontingency from Table 10, “Plan Rates”, this represents the total administrativeexpenses and taxes and fees. Profit, margin, and administrative expenses do not varyby plan.

Administrative Expense Load

The administrative expense load ($41.51; 7.03% of Premium) was provided by PHW.This allowance is based on projected enrollment and is estimated to appropriately coverexpenses for overhead, operations, sales, and marketing expenses.

There is an additional amount to cover approved quality improvement expenses ($3.00)and provider incentive payments ($2.00).

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The administrative expenses are allocated proportionally by plan on a constantpercentage of premium basis.

Profit (or Contribution to Surplus) & Risk Margin:

This load ($10.33; 1.75% of Premium) was applied proportionally to all products andplans and can be found in Appendix 12.2.

A breakdown of administrative expenses can be found in Appendix 12.2.

Taxes and Fees

The taxes and fees ($36.76) which may be subtracted from premiums for purposes ofcalculating the MLR are listed in Appendix 12.2.

For 2020, the Risk Adjustment User Fee is included as part of Taxes and Fees onWorksheet 2, Field #3.7 of the URRT.

Broker Commissions

'''''''''''' ''''''''''''''''''' ''' '''''''''''''''''''' '''''''''''''''''''' ''''' '''''''''''''''''''''''''' ''''''''''''''''''''' ''''''''' '''''''''''''''''''' '''''''''''''''''''''''''' '''''''''''''''' ''''' ''''' '''''''''''''''''''''' '''''''''''''' ''''''''''''''''''''''' ''''''''' '''''' '''''''''''''''' ''''''''''''' '''''''''' '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''' ''''''' '''''''''''''''''' ''''''''''''''''''''''''''''' ''''''''''''''''' ''''''''' ''''''''''''''''''' ''''''''''' ''''''''''''''''' ''''''''''''''''''''''''''''''''''' '''''''' '''''''''''''''' ''''''''''''' '''''''''' ''''''''''''''' '''''''''''''''''''''''''' '''''''''' ''''''''' ''''' ''''''''''''''''''''''' '''''''''''''''''''''''' ''''''''''''''''''''''''''''''''''''''''' '''''''''' '''''''''''''''''''''''''''''''''''' '''''''''''''''''''''''''''' ''''''''''''''''' ''''''''''''''''''''''' ''''''''''''''''' ''''''' '''''''''''''''''''''''''''''''''''''''' ''''' '''''''''' '''''''''''''''''''' ''''''''' '''''''' '''''''''''''''''''''''''' ''''''''''''''''''''' ''''''''''''' ''''' ''''''''''''''''''''''''''''''''''''''''''''' ''''''''' '''''''''''''''' '''''''''''''''''''''''''

A sample producer agreement has been included in Appendix 20.2.

Loss Ratio

The projected medical loss ratio (MLR) is 90.6%. The projected MLR is based on theprescribed calculation from 45 CFR 158, but solely reflects the projection year singlerisk pool experience, rather than the three-year combined period that is used fordetermining MLR rebates. There was no credibility adjustment applied to the projectedMLR. Including a credibility adjustment would only increase the projected MLR, whichalready satisfies the MLR requirement. See Appendix 15.1 for the calculation for theprojected federal medical loss ratio.

c. Normalized Market-Adjusted Projected Allowed Total Claims

Normalization factors are shown in Table 7, “Normalized Market-Adjusted ProjectedAllowed Total Claims”. Rates were normalized for age, tobacco usage, and benefitrichness.

15

The development of the average age factor (1.729) may be found in Appendix 13.2.

The development of the average geographic factor (1.000) may be found in Appendix13.3.

The development of the average tobacco usage factor (1.006) may be found inAppendix 13.4.

The development of the average benefit richness factor (1.014) may be found inAppendix 20.3.

PHW operates in a single network. There are no network differences, and thus thenetwork factor is 1.000.

d. Components of Rate Change

Please see Table 8, “Components of Rate Change”, and Table 9, “Year-over-Year Datato Support Table 8” for the buildup of the components of rate change.

16

3. Plan Rate Development

Table 10, “Plan Rate Development” shows the development of the final 2020 rates by plan.

The buildup of the Induced Utilization shown in column L of Table 10 is shown in Table Bbelow.

The buildup of this factor can also be found in Appendix 20.3. Values in column (9) representthe pure induced utilization for each plan. Additional support for the development of the AV andCost Sharing Factor for each plan can be found in Appendix 20.4.

Table BPennsylvania Health & Wellness, Inc.

Induced Utilization Buildup

(1) (2) (3) (4) (5) (6) (7) (8) (9)= (8) / (6 * 7)

Projected Projected Projected Paid to Allowed Average AV & Cost-Sharing InducedPlan ID Metal Level Membership Allowed Claims Paid Claims Factor Tobacco Factor Factor Utilization86199PA0010025 Gold 1,344 $803,834.95 $708,921.29 0.882 0.994 0.975 1.11286199PA0010005 Silver 8,856 4,799,423.73 4,276,950.12 0.891 0.994 0.893 1.00886199PA0010004 Silver 31,591 17,231,597.80 15,072,071.19 0.875 0.994 0.882 1.01486199PA0010012 Silver 21,953 11,945,259.78 10,334,892.79 0.865 0.994 0.871 1.01286199PA0010014 Silver 3,446 1,885,246.10 1,780,553.55 0.944 0.994 0.956 1.01786199PA0010015 Silver 44 24,695.14 22,685.99 0.919 0.994 0.954 1.04486199PA0010002 Bronze 15,835 8,266,262.26 5,753,914.87 0.696 0.994 0.672 0.97186199PA0010022 Bronze 12 6,498.50 4,662.92 0.718 0.994 0.719 1.00786199PA0010024 Bronze 5,972 3,264,277.23 2,364,418.18 0.724 0.994 0.732 1.01786199PA0010006 Bronze 15,828 8,294,830.68 6,034,964.97 0.728 0.994 0.705 0.97586199PA0020025 Gold 94 56,220.60 49,582.29 0.882 0.994 0.975 1.11286199PA0020005 Silver 653 353,887.05 315,362.29 0.891 0.994 0.893 1.00886199PA0020004 Silver 2,328 1,269,828.74 1,110,689.18 0.875 0.994 0.882 1.01486199PA0020012 Silver 1,624 883,665.19 764,536.32 0.865 0.994 0.871 1.01286199PA0020014 Silver 253 138,411.86 130,725.49 0.944 0.994 0.956 1.01786199PA0020015 Silver 4 2,245.01 2,062.36 0.919 0.994 0.954 1.04486199PA0020002 Bronze 1,096 572,139.15 398,250.12 0.696 0.994 0.672 0.97186199PA0020006 Bronze 1,096 574,370.38 417,887.39 0.728 0.994 0.705 0.975Total 112,029 $60,372,694.14 $49,543,131.32 0.821 0.994 0.818 1.002

17

4. Plan Premium Development for 21-Year Old Non-Tobacco User

Table 11, “Plan Premium Development for 21-Year-Old Non-Tobacco User” shows thepremium development for a 21-year-old non-tobacco user.

18

5. Plan Factors

a. Age and Tobacco Factors

Age and tobacco factors are shown in Table 12, “Age and Tobacco Factors”. Agefactors represent the federal standard age curve.

The tobacco factor for 2020 is set to 1.15 for all ages 18+. In lieu of credible data, thefactor was selected from a reasonable range of cost impacts based on tobacco costliterature. Specifically, the report “The Business Case for Coverage of TobaccoCessation, 2012 Update” by Leif Associates, Inc. was considered which suggests thathealthcare costs for smokers are greater than those of non-smokers and may be asmuch as 34% higher than costs for non-smokers.

b. Geographic Factors

The Geographic Areas used are consistent with those defined by the state. Geographicfactors are shown in Table 13, “Geographic Factors”.

c. Network Factors

Network factors are shown in Table 14, “Network Factors”. PHW only has one network,so this factor is shown as 1.0.

d. Service Area Composition

Not Applicable. Rates do not vary by Service Area.

e. Composite Rating

Not Applicable. This is an individual rate filing.

19

6. Actuarial Certification

I, '''''''''''''' '''''''''''''''' am a member of the American Academy of Actuaries in good standing andmeet its qualification standards for actuaries issuing statements of actuarial opinion in theUnited States promulgated by the American Academy of Actuaries, and have the educationand experience necessary to perform the work. This filing is prepared on behalf ofPennsylvania Health & Wellness, Inc. (the “Company”) to comply with applicable State andFederal Statutes for individual rate filings.

I am affiliated with Milliman, Inc. (“Milliman”), an independent actuarial consulting firm that isnot affiliated with, nor a subsidiary of, nor in any way owned or controlled by a health plan,health insurer, or a trade association of health plans or insurers.

I certify the rates were developed in accordance with the appropriate Actuarial Standards ofPractice (ASOPs) and the profession’s Code of Professional Conduct. While other ASOPsapply, particular emphasis was placed on the following:

· ASOP No. 5, Incurred Health and Disability Claims· ASOP No. 8, Regulatory Filings for Health Benefits, Accident and Health Insurance, and

Entities Providing Health Benefits· ASOP No. 12, Risk Classification· ASOP No. 23, Data Quality· ASOP No. 25, Credibility Procedures· ASOP No. 26, Compliance with Statutory and Regulatory Requirements for the

Actuarial Certification of Small Employer Health Benefit Plans· ASOP No. 41, Actuarial Communications· ASOP No. 42, Health and Disability Actuarial Assets and Liabilities Other Than

Liabilities for Incurred Claims· ASOP No. 45, The Use of Health Status Based Risk Adjustment Methodologies· ASOP No. 50, Determining Minimum Value and Actuarial Value under the Affordable

Care Act

I certify that to the best of my knowledge and judgment:

1. The Index Rate for the Projection Period is:

a. In compliance with all applicable State and Federal Statutes and Regulations (45CFR 156.80 and 147.102)

b. Developed in compliance with the applicable Actuarial Standards of Practice

c. Reasonable in relation to the benefits provided and the population anticipated tobe covered

20

d. Neither excessive nor deficient based on my best estimates of the 2020individual market.

2. The Index Rate and only the allowable modifiers as described in 45 CFR 156.80(d)(1)and 45 CFR 156.80(d)(2) were used to generate plan-level rates.

3. The geographic rating factors used reflect only differences in the cost of delivery (whichcan include unit cost and provider practice pattern differences) and do not includedifferences for population morbidity by geographic area.

4. The CMS Actuarial Value Calculator was used to determine the AV Metal Values shownin Worksheet 2, Section I of the URRT for all plans.

5. All factor, benefit, and other changes from the 2019 filing have been disclosed.

6. No new plan is a modification of an existing plan.

7. The information presented in the PA Actuarial Memorandum and PA ActuarialMemorandum Rate Exhibits is consistent with the information presented in the 2020Rate Filing Justification.

The URRT does not demonstrate the process used to develop proposed premium rates. It isrepresentative of information required by Federal regulation to be provided in support of thereview of rate increases, for certification of qualified health plans and for certification that theIndex Rate is developed in accordance with Federal regulation and used consistently and onlyadjusted by the allowable modifiers.

The 2020 plan year premium rates in this actuarial memorandum are contingent upon thestatus of the ACA statutes and regulations including any regulatory guidance, court decisions,or otherwise. Changes have the potential to greatly impact the 2020 plan year premium ratesprovided in this Actuarial Memorandum and the alignment of these premium rates withincurred costs. Changes include, but are not limited to, any legislative or regulatoryamendment, court decision, 1332 waivers bringing reinsurance or other such programs to astate; or a decision by Congress, the Health and Human Services Secretary, or the Centers forMedicare and Medicaid Services director to fund cost-sharing reduction subsidies, alteradvance premium tax credits, or further modify the individual mandate requirement andpenalty. In the event that a material provision is impacted, a revision to the rates will beneeded. In particular, rates were developed assuming steady funding of Advanced PremiumTax Credits (APTCs) and no funding of cost-sharing reduction (CSR) subsidy payments. Thecontinuity of this funding approach will impact whether rates are sufficient and not excessive.Milliman expresses no opinion with regard to the future funding of CSR payments.

The information provided in this actuarial memorandum is in support of the items illustrated inthe URRT and does not provide an actuarial opinion regarding the URRT’s process used to

21

develop proposed premium rates. It does certify that rates were developed in accordance withapplicable regulations, as noted.

It is certain that actual experience will not conform exactly to the assumptions used in thisanalysis.

Signed:

Name: '''''''''''' '''''''''''''''

Title: Consulting Actuary

Date: June 24, 2019

PA Rate Template Part IData Relevant to the Rate Filing

Table 0. Identifying Information

Carrier Name: Pennsylvania Health & Wellness, Inc.Product(s): HMOMarket Segment: Individual

Rate Effective Date: 1/1/2020 to 12/31/2020Base Period Start Date 1/1/2018 to 12/31/2018Date of Most Recent Membership 2/1/2019

Table 1. Number of Members

Member-months Members Member-months

Experience PeriodCurrent Period

(as of 02-01-2019)Projected Rating Period

Average Age 43.3 49.0

Total 0 1,869 112,029<18 30 1,532

18-24 137 7,334

25-29 234 13,659

30-34 208 13,060

35-39 179 10,304

40-44 174 10,604

45-49 166 10,005

50-54 220 13,000

55-59 233 14,078

60-63 216 13,180

64+ 72 5,272

*Tables 1, 2 and 4 must include data for all non-grandfathered business (ACA compliant and Transitional)

Table 2. Experience Period Claims and Premiums

Earned Premium Paid Claims Ultimate Incurred Claims Member MonthsEstimated Cost Sharing

(Member & HHS)Allowed Claims (Non-Capitated)

Non-EHB portion of AllowedClaims

Total Prescription Drug Rebates* Total EHB Capitation Total Non-EHB Capitation Estimated Risk Adjustment

-Experience Period Total Allowed EHB Claims + EHB Capitation PMPM (net of prescription drug rebates) -$Loss Ratio 0.00%*Express Prescription Drug Rebates as a negative number

Table 3. Trend Components

Cost* Utilization* Induced Demand* Composite Trend Weight*0.00%0.00%0.00%0.00%

0.00%0.00% 0.00%

241.000

* Express Cost, Utilization, Induced Utilization and Weight as percentages** Should = URRT Trend

Table 4. Historical Experience

Month-Year Total Annual Premium Incurred Claims Completion Factors* Ultimate Incurred Claims Members Ultimate Incurred PMPMEstimated Annual Cost Sharing

(Member + HHS)Prescription Drug Rebates**

Allowed Claims (Net ofPrescription Drug Rebates)

Allowed PMPM

Jan-15 #DIV/0! #DIV/0! #DIV/0!Feb-15 #DIV/0! #DIV/0! #DIV/0!Mar-15 #DIV/0! #DIV/0! #DIV/0!Apr-15 #DIV/0! #DIV/0! #DIV/0!

May-15 #DIV/0! #DIV/0! #DIV/0!Jun-15 #DIV/0! #DIV/0! #DIV/0!Jul-15 #DIV/0! #DIV/0! #DIV/0!

Aug-15 #DIV/0! #DIV/0! #DIV/0!Sep-15 #DIV/0! #DIV/0! #DIV/0!Oct-15 #DIV/0! #DIV/0! #DIV/0!Nov-15 #DIV/0! #DIV/0! #DIV/0!Dec-15 #DIV/0! #DIV/0! #DIV/0!Jan-16 #DIV/0! #DIV/0! #DIV/0!Feb-16 #DIV/0! #DIV/0! #DIV/0!Mar-16 #DIV/0! #DIV/0! #DIV/0!Apr-16 #DIV/0! #DIV/0! #DIV/0!






Aug-18 #DIV/0! #DIV/0! #DIV/0!Sep-18 #DIV/0! #DIV/0! #DIV/0!Oct-18 #DIV/0! #DIV/0! #DIV/0!Nov-18 #DIV/0! #DIV/0! #DIV/0!Dec-18 #DIV/0! #DIV/0! #DIV/0!

* Express Completion Factor as a percentage**Express Prescription Drug Rebates as a negative number

Service CategoryInpatient HospitalOutpatient Hospital

Total Applied Trend Projection Factor

ProfessionalOther MedicalCapitationPrescription DrugsTotal Annual TrendMonths of Trend

Carrier Name: Pennsylvania Health & Wellness, Inc.Product(s): HMOMarket Segment: IndividualRate Effective Date: 1/1/2020

Table 2b. Manual Experience Period Claims and Premiums

Earned Premium Paid Claims Ultimate Incurred Claims Member Months Estimated Cost Sharing(Member & HHS)

Allowed Claims (Non-Capitated) Non-EHB portion of AllowedClaims

Total Prescription Drug Rebates* Total EHB Capitation Total Non-EHB Capitation Estimated Risk Adjustment

$ 3,549,562,536.45 $ 3,052,623,781.35 $ 3,052,623,781.35 12,000,000 $ 1,308,267,334.86 $ 4,360,891,116.21 $ - $ - $ 20,812,606.20 $ - -$Experience Period Total Allowed EHB Claims + EHB Capitation PMPM (net of prescription drug rebates) 365.14$Loss Ratio 86.59%*Express Prescription Drug Rebates as a negative number

Table 3b. Manual Trend Components

Cost* Utilization* Induced Utilization* Composite Trend Weight*11.63% 7.94% -2.56% 17.41% 21.73%8.10% 2.24% -2.79% 7.43% 21.04%8.72% 4.36% -2.79% 10.30% 27.50%-0.83% 0.37% -5.63% -6.07% 2.67%

0.00% 0.47%6.78% 0.68% -2.27% 5.06% 26.59%

9.49% 100.00%24

1.199* Express Cost, Utilization, Induced Utilization and Weight as percentages

Table 4b. Historical Manual Experience

Month-Year Total Annual Premium Incurred Claims Completion Factors* Ultimate Incurred Claims Members Ultimate Incurred PMPMEstimated Annual Cost Sharing

(Member + HHS)Prescription Drug Rebates**

Allowed Claims (Net ofPrescription Drug Rebates)

Allowed PMPM

Jan-15 $ 229,657,659.48 1.0000 $ 229,657,659.48 1,000,000 $ 229.66 $ - $ 328,082,370.69 $ 328.08Feb-15 $ 230,224,057.22 1.0000 $ 230,224,057.22 1,000,000 $ 230.22 $ - $ 328,891,510.32 $ 328.89

Mar-15 $ 230,791,851.86 1.0000 $ 230,791,851.86 1,000,000 $ 230.79 $ - $ 329,702,645.51 $ 329.70Apr-15 $ 231,361,046.83 1.0000 $ 231,361,046.83 1,000,000 $ 231.36 $ - $ 330,515,781.18 $ 330.52

May-15 $ 231,931,645.58 1.0000 $ 231,931,645.58 1,000,000 $ 231.93 $ - $ 331,330,922.26 $ 331.33Jun-15 $ 232,503,651.59 1.0000 $ 232,503,651.59 1,000,000 $ 232.50 $ - $ 332,148,073.70 $ 332.15Jul-15 $ 233,077,068.32 1.0000 $ 233,077,068.32 1,000,000 $ 233.08 $ - $ 332,967,240.45 $ 332.97

Aug-15 $ 233,651,899.24 1.0000 $ 233,651,899.24 1,000,000 $ 233.65 $ - $ 333,788,427.49 $ 333.79Sep-15 $ 234,228,147.86 1.0000 $ 234,228,147.86 1,000,000 $ 234.23 $ - $ 334,611,639.80 $ 334.61Oct-15 $ 234,805,817.66 1.0000 $ 234,805,817.66 1,000,000 $ 234.81 $ - $ 335,436,882.37 $ 335.44Nov-15 $ 235,384,912.15 1.0000 $ 235,384,912.15 1,000,000 $ 235.38 $ - $ 336,264,160.22 $ 336.26Dec-15 $ 235,965,434.85 1.0000 $ 235,965,434.85 1,000,000 $ 235.97 $ - $ 337,093,478.35 $ 337.09Jan-16 $ 236,547,389.27 1.0000 $ 236,547,389.27 1,000,000 $ 236.55 $ - $ 337,924,841.81 $ 337.92Feb-16 $ 237,130,778.94 1.0000 $ 237,130,778.94 1,000,000 $ 237.13 $ - $ 338,758,255.63 $ 338.76

Mar-16 $ 237,715,607.41 1.0000 $ 237,715,607.41 1,000,000 $ 237.72 $ - $ 339,593,724.88 $ 339.59Apr-16 $ 238,301,878.23 1.0000 $ 238,301,878.23 1,000,000 $ 238.30 $ - $ 340,431,254.62 $ 340.43

May-16 $ 238,889,594.95 1.0000 $ 238,889,594.95 1,000,000 $ 238.89 $ - $ 341,270,849.93 $ 341.27Jun-16 $ 239,478,761.14 1.0000 $ 239,478,761.14 1,000,000 $ 239.48 $ - $ 342,112,515.91 $ 342.11Jul-16 $ 240,069,380.37 1.0000 $ 240,069,380.37 1,000,000 $ 240.07 $ - $ 342,956,257.67 $ 342.96


Mar-17 $ 244,847,075.64 1.0000 $ 244,847,075.64 1,000,000 $ 244.85 $ - $ 349,781,536.62 $ 349.78Apr-17 $ 245,450,934.58 1.0000 $ 245,450,934.58 1,000,000 $ 245.45 $ - $ 350,644,192.25 $ 350.64

May-17 $ 246,056,282.80 1.0000 $ 246,056,282.80 1,000,000 $ 246.06 $ - $ 351,508,975.43 $ 351.51Jun-17 $ 246,663,123.97 1.0000 $ 246,663,123.97 1,000,000 $ 246.66 $ - $ 352,375,891.39 $ 352.38Jul-17 $ 247,271,461.78 1.0000 $ 247,271,461.78 1,000,000 $ 247.27 $ - $ 353,244,945.40 $ 353.24


Mar-18 $ 252,192,487.91 1.0000 $ 252,192,487.91 1,000,000 $ 252.19 $ - $ 360,274,982.72 $ 360.27Apr-18 $ 252,814,462.61 1.0000 $ 252,814,462.61 1,000,000 $ 252.81 $ - $ 361,163,518.02 $ 361.16

May-18 $ 253,437,971.28 1.0000 $ 253,437,971.28 1,000,000 $ 253.44 $ - $ 362,054,244.69 $ 362.05Jun-18 $ 254,063,017.69 1.0000 $ 254,063,017.69 1,000,000 $ 254.06 $ - $ 362,947,168.13 $ 362.95Jul-18 $ 254,689,605.63 1.0000 $ 254,689,605.63 1,000,000 $ 254.69 $ - $ 363,842,293.76 $ 363.84

Aug-18 $ 255,317,738.91 1.0000 $ 255,317,738.91 1,000,000 $ 255.32 $ - $ 364,739,627.01 $ 364.74Sep-18 $ 255,947,421.33 1.0000 $ 255,947,421.33 1,000,000 $ 255.95 $ - $ 365,639,173.33 $ 365.64Oct-18 $ 256,578,656.72 1.0000 $ 256,578,656.72 1,000,000 $ 256.58 $ - $ 366,540,938.17 $ 366.54Nov-18 $ 257,211,448.90 1.0000 $ 257,211,448.90 1,000,000 $ 257.21 $ - $ 367,444,927.00 $ 367.44Dec-18 $ 257,845,801.72 1.0000 $ 257,845,801.72 1,000,000 $ 257.85 $ - $ 368,351,145.32 $ 368.35

* Express Completion Factor as a percentage**Express Prescription Drug Rebates as a negative number

Capitation

Service CategoryInpatient HospitalOutpatient HospitalProfessionalOther Medical

$ 3,446,177,219.86 $ 1,270,162,461.03

$ 3,549,562,536.45 $ 1,308,267,334.86

Prescription DrugsTotal Annual TrendMonths of TrendTotal Applied Trend Projection Factor

$ 3,345,803,126.07 $ 1,233,167,437.90

$ 3,248,352,549.59 $ 1,197,249,939.70

PA Rate Template Part IIRate Development and ChangeCarrier Name: Pennsylvania Health & Wellness, Inc.Product(s): HMO

Market Segment: Individual

Rate Effective Date: 1/1/2020

Table 5. Development of the Projected Index Rate, Market-Adjusted Index Rate, and Total Allowed Claims

Development of the Projected Index Rate Actual Experience Data Manual Data

Total Allowed EHB Claims + EHB Capitation PMPM (net of prescription drug rebates) PMPM -$ 365.14$ <- Actual Experience PMPM should be consistent with the Index Rate for Experience Period on URRT

Two year trend projection Factor 1.000 1.199

Unadjusted Projected Allowed EHB Claims PMPM -$ 437.70$ For Informational Purposes only - No input required.Single Risk Pool Adjustment Factors

Change in Morbidity 1.000 1.104 <- See URRT Instructions Blended Base Period Unadjusted Claims before Normalization 365.14$ <- Index Rate of Experience Period on URRT Change in Other 1.000 1.112 Blended Earned Premium 3,549,562,536.45$ Change in Demographics 1.000 1.207 <- See URRT Instructions Blended Loss Ratio 86.59% Change in Network 1.000 0.931 Change in Benefits 1.000 0.985 <- See URRT Instructions

Change in Other 1.000 1.004 <- See URRT Instructions

Total Adjusted Projected Allowed EHB Claims PMPM -$ 537.19$

Credibidility Factors 0% 100% <- See InstructionsBlended Projected EHB Claims PMPM 537.19$ <- Projected Index Rate Development of the Market-Adjusted Index Rate and Total Allowed Claims

Adjusted Projected Allowed EHB Claims PMPM 537.19$ <- Index Rate for Projection Period on URRT - Individual or First Quarter Small Group Table 5A. Small Group Projected Index Rate with Quarterly TrendAdjusted Projected Allowed EHB Claims PMPM [will only populate for small group filings] -$ Projected Paid to Allowed Ratio 0.821 Effective Date 1/1/2020 4/1/2020 7/1/2020 10/1/2020 Total Single Risk PoolProjected Paid EHB Claims PMPM 440.83$ # of Member Months Renewing in Quarter -Market-wide Adjustments Adjusted Projected Allowed EHB Claims PMPM Q1 537.19$ 537.19$ 537.19$ 537.19$ 537.19$ Projected Risk Adjustment PMPM (54.56)$ Months of Trend - 3 6 9 Projected Paid Exchange User Fees PMPM 17.66$ Annual Trend 9.49% 9.49% 9.49% 9.49%

Single Risk Pool Projected Allowed Claims 537.19$ 549.50$ 562.09$ 574.97$ -$Market-Adjusted Projected Paid EHB Claims PMPM 513.04$ Quarterly Trend Factor 100.0% 102.3% 104.6% 107.0% 0.0%

2020 Trend Factors by Quarter #DIV/0! #DIV/0! #DIV/0! #DIV/0!Market-Adjusted Projected Allowed EHB Claims PMPM 625.19$ <- Market-Adjusted Index Rate

Projected Allowed Non-EHB Claims PMPM 1.89$

Market-Adjusted Projected Paid Total Claims PMPM 514.60$

Market-Adjusted Projected Allowed Total Claims PMPM 627.08$

Table 6. Retention Table 7. Normalized Market-Adjusted Projected Allowed Total Claims

Retention Items - Express in percentages Percentages PMPM Amounts Normalization Factors 2019 2020Administrative Expenses 7.86% $46.43 Average Age Factor 1.731 1.729 General and Claims 6.47% $38.17 Average Geographic Factor 1.000 1.000 Agent/Broker Fees and Commissions 0.55% $3.26 Average Tobacco Factor 1.004 1.006 Quality Improvement Initiatives 0.85% $5.00 Average Benefit Richness (induced demand) 1.029 1.000Taxes and Fees 3.23% $19.04 Average Network Factor 1.000 1.000 RA User Fee 0.03% $0.18 PA Premium Tax (if applicable) 0.27% $1.60 Market-Adjusted Projected Allowed Total Claims PMPM 642.43$ 627.08$ Federal Income Tax 0.54% $3.17

Health Insurance Providers Fee (Prorated for Small Groups only) 2.39% $14.09 Normalized Market-Adjusted Projected Allowed Total Claims PMPM 358.94$ 360.70$

Profit/Contingency (after tax) 1.75% $10.33

Total Retention 12.84% $75.81

Projected Required Revenue PMPM 590.41$

Table 8. Components of Rate Change Table 9. Year-over-Year Data to Support Table 8

Rate Components 2019 2020 Difference Percent Change 2019 2020A. Calibrated Plan Adjusted Index Rate (PMPM) 341.04$ 336.40$ -$4.63 -1.4% Paid-to-Allowed 0.840 0.821

B. Base period allowed claims before normalization 480.75$ 365.14$ -$115.61 -33.9% URRT Trend (Total Applied Trend Factor) 0.889 1.199 <- URRT W1, S2C. Normalization factor component of change (212.15)$ (155.11)$ $57.03 16.7% URRT Morbidity 0.944 1.104 <- URRT W1, S2

URRT "Other" 1.152 1.112 <- URRT W1, S2D. Change in Normalized Allowed Claims Adjustment Components D1. Base period allowed claims after normalization 268.61$ 210.03$ (58.58)$ -17.2% Risk Adjustment 127.40$ 54.56$ <- URRT W1, S3 D2. URRT Trend (29.83)$ 41.73$ 71.57$ 21.0% Exchange User Fee 21.71$ 17.66$ <- URRT W1, S3 D3. URRT Morbidity (13.41)$ 26.14$ 39.54$ 11.6% Capitation 2.44$ 1.73$ <- URRT W1, S2 D4. URRT Other 34.35$ 31.09$ (3.26)$ -1.0% D5. Normalized URRT RA/RI on an allowed basis 84.77$ 38.24$ (46.53)$ -13.6% Network 1.000 1.000 D6. Normalized Exchange User Fee on an allowed basis 14.45$ 12.38$ (2.07)$ -0.6% Pricing AV 0.848 0.814 <- For 2019 in cell J81, please include a factor equal to the product of the average Pricing AV and the Non-Funding of CSR Adjustment D7. Subtotal - Sum(D1:D6) 358.94$ 359.61$ 0.67$ 0.2% Benefit Richness 1.060 1.000E. Change in Allowable Plan Adjusted Level Components Catastrophic Eligibility 1.000 1.000 E1. Network -$ -$ -$ 0.0% E2. Pricing AV -54.49139094 (67.06)$ (12.57)$ -3.7% Administrative Expenses 8.90% 7.86% E3. Benefit Richness 18.14$ -$ (18.14)$ -5.3% Taxes and Fees 2.15% 3.23% E4. Catastrophic Eligibility -$ 0.00$ 0.00$ 0.0% Profit and/or Contingency 2.00% 1.75% E5. Subtotal - Sum(E1:E4) (36.35)$ (67.06)$ (30.71)$ -9.0%F. Change in Retention Components F1. Administrative Expenses 30.36$ 26.46$ (3.91)$ -1.1% F2. Taxes and Fees 7.33$ 10.85$ 3.52$ 1.0% F3. Profit and/or Contingency 6.82$ 5.89$ (0.93)$ -0.3% F4. Subtotal - Sum(F1:F3) 44.51$ 43.20$ (1.32)$ -0.4%

G. Change in Miscellaneous Items -$ -$ -$ 0.0%

H. Sum of Components of Rate Change (should approximate the change shown in line A) 367.10$ 335.75$ (31.35)$ -9.2%

PA Rate Template Part IIITable 10. Plan Rates

Carrier Name: Pennsylvania Health & Wellness, Inc.Product(s): HMOMarket Segment: Individual

Rate Effective Date: 1/1/2020Base Period Start Date 1/1/2018Date of Most Recent Membership 2/1/2019

Market Adjusted Index Rate 625.19$

Plan Number

HIOS Plan ID(Standard

Component)

Plan Type(HMO, POS, PPO, EPO,

Indemnity, Other)1/1/2019 Plan

Marketing Name

Existing, Modified,New, Discontinued &

Mapped, Discontinued& Not Mapped

(E,M,N,DM, DNM) for2020

1/1/2020 Plan HIOSPlan ID (If 1/1/2019 Plan

Discontinued &Mapped) Metallic Tier

Metallic TierActuarial

Value

Standard AV,Approach (1),Approach (2)

ExchangeOn/Off or

Off

Pricing AV(company-

determinedAV)

BenefitRichness(induceddemand)

Benefits inaddition to

EHBProviderNetwork

CatastrophicEligibility

Non-Fundingof CSR

Adjustment Pure Premium

Totals 0.664 0.814 1.000 1.000 1.000 1.000 1.128 509.75$

Transitional Plans TRANSITIONAL N/A TRANSITIONAL DNM TRANSITIONAL N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/APlan 1 86199PA0010002 HMO Ambetter Essential Care 1 (2020) E Bronze 0.60322544 Standard AV On/Off 0.695 0.971 1.000 1.000 1.000 1.000 $421.55

Plan 2 86199PA0010022 HMO Ambetter Essential Care 2 HSA (2020) N Bronze 0.62452802 Standard AV On/Off 0.716 1.007 1.000 1.000 1.000 1.000 $450.79

Plan 3 86199PA0010024 HMO Ambetter Essential Care 4 HSA (2020) N Bronze 0.63192907 Standard AV On/Off 0.723 1.017 1.000 1.000 1.000 1.000 $459.31Plan 4 86199PA0010006 HMO Ambetter Essential Care 10 (2020) N Bronze 0.63751775 Standard AV On/Off 0.726 0.975 1.000 1.000 1.000 1.000 $442.33Plan 5 86199PA0010005 HMO Ambetter Balanced Care 5 (2020) E Silver 0.69040758 Standard AV On/Off 0.741 1.008 1.000 1.000 1.000 1.200 $560.27Plan 6 86199PA0010004 HMO Ambetter Balanced Care 11 (2020) E Silver 0.69455839 Standard AV On/Off 0.727 1.014 1.000 1.000 1.000 1.200 $553.49Plan 7 86199PA0010012 HMO Ambetter Balanced Care 12 (2020) N Silver 0.6803266 Standard AV On/Off 0.719 1.012 1.000 1.000 1.000 1.200 $546.15Plan 8 86199PA0010003 HMO Ambetter Balanced Care 3 (2019) DM 86199PA0010014 Silver 0.7183 Standard AV On/Off 0.785 1.017 1.000 1.000 1.000 1.200 $599.43Plan 9 86199PA0010014 HMO Ambetter Balanced Care 14 (2020) N Silver 0.71485039 Standard AV On/Off 0.785 1.017 1.000 1.000 1.000 1.200 $599.43Plan 10 86199PA0010015 HMO Ambetter Balanced Care 15 (2020) N Silver 0.71962837 Standard AV On/Off 0.764 1.044 1.000 1.000 1.000 1.200 $598.15

Plan 11 86199PA0010001 HMOAmbetter Secure Care 1 (2019) with 3Free PCP Visits DM 86199PA0010025 Gold 0.8035 Standard AV On/Off 0.880 1.112 1.000 1.000 1.000 1.000 $611.93

Plan 12 86199PA0010025 HMO Ambetter Secure Care 5 (2020) N Gold 0.8170327 Standard AV On/Off 0.880 1.112 1.000 1.000 1.000 1.000 $611.93

Plan 13 86199PA0020002 HMOAmbetter Essential Care 1 (2020) +Vision + Adult Dental N Bronze 0.60322544 Standard AV On/Off 0.695 0.971 1.047 1.000 1.000 1.000 $441.34

Plan 14 86199PA0020006 HMOAmbetter Essential Care 10 (2020) +Vision + Adult Dental N Bronze 0.63751775 Standard AV On/Off 0.726 0.975 1.047 1.000 1.000 1.000 $463.11

Plan 15 86199PA0020005 HMOAmbetter Balanced Care 5 (2020) +Vision + Adult Dental N Silver 0.69040758 Standard AV On/Off 0.741 1.008 1.047 1.000 1.000 1.200 $586.58





Plan 20 86199PA0020025 HMOAmbetter Secure Care 5 (2020) + Vision+ Adult Dental N Gold 0.8170327 Standard AV On/Off 0.880 1.112 1.047 1.000 1.000 1.000 $640.67

45 CFR Part 156.8 (d) (2) Allowable Factors

Age Calibration Factor 1.729Geographic Calibration Factor 1.000Tobacco Calibration Factor 1.006Aggregate Calibration Factor 1.739

Admin Costs

Taxes & Fees (notincluding Exchange

fees)Profit or

Contingency

TotalCovered Lives

Mapped into 2020Plans @ 02-01-

2019Total Policyholders

@ 02-01-2019

2019 CalibratedPlan Adjusted

Index RatePMPM

2020 CalibratedPlan Adjusted

Index RatePMPM

Proposed RateChange

Compared toPrior 12months

% of TotalCovered Lives 1 2 3 4 5 6 7 8 9 Total

2020Continued/Discontined

PlansIndicator

7.9% 3.2% 1.8% 1,869 1,547 341.04$ 336.40$ -1.4% - - - - - - - 1,869 - 1,869

N/A N/A N/A - - N/A N/A N/A N/A - - - - - - - - - - 07.9% 3.2% 1.8% 646 541 293.11$ 278.20$ -5.1% 34.6% - - - - - - - 646 - 646 1

7.9% 3.2% 1.8% - - 297.50$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 303.12$ 0.0% 0.0% - - - - - - - - - - 17.9% 3.2% 1.8% - - 291.91$ 0.0% 0.0% - - - - - - - - - - 17.9% 3.2% 1.8% 192 158 369.40$ 369.74$ 0.1% 10.3% - - - - - - - 192 - 192 17.9% 3.2% 1.8% 990 817 363.82$ 365.27$ 0.4% 53.0% - - - - - - - 990 - 990 17.9% 3.2% 1.8% - - 360.43$ 0.0% 0.0% - - - - - - - - - - 17.9% 3.2% 1.8% 17 15 416.22$ 395.59$ -5.0% 0.9% - - - - - - - 17 - 17 17.9% 3.2% 1.8% - - 395.59$ 0.0% 0.0% - - - - - - - - - - 17.9% 3.2% 1.8% - - 394.74$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% 24 16 410.88$ 403.83$ -1.7% 1.3% - - - - - - - 24 - 24 17.9% 3.2% 1.8% - - 403.83$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 291.26$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 305.62$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 387.11$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 382.42$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 377.35$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 414.17$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 413.28$ 0.0% 0.0% - - - - - - - - - - 1

7.9% 3.2% 1.8% - - 422.80$ 0.0% 0.0% - - - - - - - - - - 1

02-01-2019 Number of Covered Lives by Rating Area

Calibration Total Covered Lives @ 02-01-20191,869

PA Rate Template Part IV A - IndividualTable 11. Plan Premium Development for 21-Year-Old Non-Tobacco User

Carrier Name: Pennsylvania Health & Wellness, Inc.Product(s): HMOMarket Segment: IndividualRate Effective Date: 1/1/2020

Plan NumberHIOS Plan ID (Standard

Component)1/1/2019 Plan

Marketing Name

Discontinued,New, Modified,

Existing(D,N,M,E) for

2020

1/1/2020 Plan HIOS PlanID (If 1/1/2019 Plan

Discontinued & Mapped) Metallic Tier

ExchangeOn/Off or

Off 1 2 3 4 5 6 7 8

Totals -$ -$ -$ -$ -$ -$ -$ 341.04$

Plan 1 86199PA0010002 Ambetter Essential Care 1 (2020) E Bronze On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 293.11$Plan 2 86199PA0010022 Ambetter Essential Care 2 HSA (2020) N Bronze On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 3 86199PA0010024 Ambetter Essential Care 4 HSA (2020) N Bronze On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 4 86199PA0010006 Ambetter Essential Care 10 (2020) N Bronze On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 5 86199PA0010005 Ambetter Balanced Care 5 (2020) E Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 369.40$Plan 6 86199PA0010004 Ambetter Balanced Care 11 (2020) E Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 363.82$Plan 7 86199PA0010012 Ambetter Balanced Care 12 (2020) N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 8 86199PA0010003 Ambetter Balanced Care 3 (2019) DM 86199PA0010014 Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 416.22$Plan 9 86199PA0010014 Ambetter Balanced Care 14 (2020) N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 10 86199PA0010015 Ambetter Balanced Care 15 (2020) N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 11 86199PA0010001 Ambetter Secure Care 1 (2019) with 3 Free PCP Visits DM 86199PA0010025 Gold On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 410.88$Plan 12 86199PA0010025 Ambetter Secure Care 5 (2020) N Gold On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 13 86199PA0020002 Ambetter Essential Care 1 (2020) + Vision + Adult Dental N Bronze On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 14 86199PA0020006 Ambetter Essential Care 10 (2020) + Vision + Adult Dental N Bronze On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 15 86199PA0020005 Ambetter Balanced Care 5 (2020) + Vision + Adult Dental N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 16 86199PA0020004 Ambetter Balanced Care 11 (2020) + Vision + Adult Dental N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 17 86199PA0020012 Ambetter Balanced Care 12 (2020) + Vision + Adult Dental N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 18 86199PA0020014 Ambetter Balanced Care 14 (2020) + Vision + Adult Dental N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 19 86199PA0020015 Ambetter Balanced Care 15 (2020) + Vision + Adult Dental N Silver On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$Plan 20 86199PA0020025 Ambetter Secure Care 5 (2020) + Vision + Adult Dental N Gold On/Off #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -$

These cells auto-fill using the data entered in Table 10.

2019 21-year-old, Non-Tobacco Premium PMPM

9

Average(weighted

byenrollment

by ratingarea) 1 2 3 4 5 6 7 8 9

Average(weighted

byenrollment

by ratingarea) 1 2 3 4 5 6 7 8 9

Average(weighted

byenrollment

by ratingarea)

-$ #VALUE! -$ -$ -$ -$ -$ -$ -$ 336.40$ -$ #VALUE! 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% -1.6% 0.0% #VALUE!

#VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 278.20$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -5.1% #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 297.50$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 303.12$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 291.91$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 369.74$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 0.1% #VALUE! #VALUE!#VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 365.27$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 0.4% #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 360.43$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 395.59$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -5.0% #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 395.59$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 394.74$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 403.83$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! -1.7% #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 403.83$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 291.26$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 305.62$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 387.11$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 382.42$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 377.35$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 414.17$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 413.28$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!#VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! 422.80$ #VALUE! -$ #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE! #VALUE!

2020 21-year-old, Non-Tobacco Premium PMPM Change in 21-year-old Non-Tobacco Premium PMPM

PA Rate Quarterly Template Part VConsumer Factors

Carrier Name: Pennsylvania Health & Wellness, Inc.

Product(s): HMO

Market Segment: Individual

Rate Effective Date: 1/1/2020

Table 12. Age and Tobacco Factors Table 13. Geographic Factors

AgeBand

AgeFactor

TobaccoFactor

AgeBand

AgeFactor

TobaccoFactor

Area Counties CurrentFactor

ProposedFactor

0-14 0.765 40 1.278 1.150 Rating Area 1 N/A15 0.833 41 1.302 1.150 Rating Area 2 N/A16 0.859 42 1.325 1.150 Rating Area 3 N/A17 0.885 43 1.357 1.150 Rating Area 4 N/A18 0.913 1.150 44 1.397 1.150 Rating Area 5 N/A19 0.941 1.150 45 1.444 1.150 Rating Area 6 N/A20 0.970 1.150 46 1.500 1.150 Rating Area 7 N/A21 1.000 1.150 47 1.563 1.150 Rating Area 8 Bucks, Montgomery, Philadelphia 1.000 1.00022 1.000 1.150 48 1.635 1.150 Rating Area 9 N/A23 1.000 1.150 49 1.706 1.15024 1.000 1.150 50 1.786 1.15025 1.004 1.150 51 1.865 1.150 Table 14. Network Factors26 1.024 1.150 52 1.952 1.15027 1.048 1.150 53 2.040 1.150

28 1.087 1.150 54 2.135 1.150 Network Name Rating AreaCurrentFactor

ProposedFactor

DOHApproval

Date29 1.119 1.150 55 2.230 1.150 Ambetter Rating Area 8 1.000 130 1.135 1.150 56 2.333 1.15031 1.159 1.150 57 2.437 1.15032 1.183 1.150 58 2.548 1.15033 1.198 1.150 59 2.603 1.15034 1.214 1.150 60 2.714 1.15035 1.222 1.150 61 2.810 1.15036 1.230 1.150 62 2.873 1.15037 1.238 1.150 63 2.952 1.15038 1.246 1.150 64+ 3.000 1.15039 1.262 1.150

*PA follows the federal default age curve.

Projection Period Age and Tobacco Factors Geographic Area Factors

Projecion Period Network Factors

RATE PAGES

Company Name:

Market:

Product:

Effective Date of Rates: Ending date of Rates:

HIOS Plan ID (On Exchange)=>

HIOS Plan ID (Off Exchange)=>

Plan Marketing Name =>

Form # =>

Rating Area =>

Network =>

Metal =>

Deductible =>

Coinsurance =>

Copays =>

OOP Maximum =>

Pediatric Dental (Yes/No) =>

Age Band Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco

0 - 14 $308.93 $308.93 $282.85 $282.85 $279.43 $279.43 $275.72 $275.72 $302.62 $302.62 $301.97 $301.97 $212.82 $212.82

15 $336.39 $336.39 $307.99 $307.99 $304.27 $304.27 $300.23 $300.23 $329.52 $329.52 $328.81 $328.81 $231.73 $231.73

16 $346.89 $346.89 $317.61 $317.61 $313.76 $313.76 $309.60 $309.60 $339.81 $339.81 $339.08 $339.08 $238.97 $238.97

17 $357.39 $357.39 $327.22 $327.22 $323.26 $323.26 $318.97 $318.97 $350.09 $350.09 $349.34 $349.34 $246.20 $246.20

18 $368.70 $424.00 $337.57 $388.21 $333.49 $383.51 $329.07 $378.43 $361.17 $415.34 $360.39 $414.45 $253.99 $292.09

19 $380.00 $437.00 $347.93 $400.11 $343.72 $395.27 $339.16 $390.03 $372.25 $428.08 $371.45 $427.16 $261.78 $301.05

20 $391.72 $450.47 $358.65 $412.44 $354.31 $407.45 $349.61 $402.05 $383.72 $441.27 $382.89 $440.33 $269.85 $310.32

21 $403.84 $464.41 $369.75 $425.21 $365.28 $420.07 $360.43 $414.50 $395.59 $454.93 $394.74 $453.95 $278.20 $319.93

22 $403.84 $464.41 $369.75 $425.21 $365.28 $420.07 $360.43 $414.50 $395.59 $454.93 $394.74 $453.95 $278.20 $319.93

23 $403.84 $464.41 $369.75 $425.21 $365.28 $420.07 $360.43 $414.50 $395.59 $454.93 $394.74 $453.95 $278.20 $319.93

24 $403.84 $464.41 $369.75 $425.21 $365.28 $420.07 $360.43 $414.50 $395.59 $454.93 $394.74 $453.95 $278.20 $319.93

25 $405.45 $466.26 $371.22 $426.90 $366.73 $421.74 $361.86 $416.14 $397.17 $456.74 $396.31 $455.76 $279.31 $321.20

26 $413.52 $475.55 $378.61 $435.41 $374.03 $430.14 $369.07 $424.43 $405.08 $465.84 $404.21 $464.84 $284.87 $327.60

27 $423.21 $486.70 $387.49 $445.61 $382.80 $440.22 $377.72 $434.38 $414.57 $476.76 $413.68 $475.73 $291.55 $335.28

28 $438.96 $504.81 $401.91 $462.19 $397.04 $456.60 $391.78 $450.55 $430.00 $494.50 $429.08 $493.44 $302.40 $347.75

29 $451.89 $519.67 $413.74 $475.80 $408.73 $470.04 $403.31 $463.81 $442.66 $509.06 $441.71 $507.96 $311.30 $357.99

30 $458.35 $527.10 $419.65 $482.60 $414.58 $476.76 $409.08 $470.44 $448.99 $516.34 $448.02 $515.23 $315.75 $363.11

31 $468.04 $538.24 $428.53 $492.81 $423.34 $486.84 $417.73 $480.39 $458.48 $527.26 $457.50 $526.12 $322.42 $370.79

32 $477.73 $549.39 $437.40 $503.01 $432.11 $496.93 $426.38 $490.34 $467.98 $538.17 $466.97 $537.02 $329.10 $378.47

33 $483.79 $556.36 $442.95 $509.39 $437.59 $503.23 $431.79 $496.55 $473.91 $545.00 $472.89 $543.83 $333.27 $383.27

34 $490.25 $563.79 $448.86 $516.19 $443.43 $509.95 $437.55 $503.19 $480.24 $552.28 $479.21 $551.09 $337.73 $388.38

35 $493.48 $567.50 $451.82 $519.60 $446.36 $513.31 $440.44 $506.50 $483.40 $555.92 $482.37 $554.72 $339.95 $390.94

36 $496.71 $571.22 $454.78 $523.00 $449.28 $516.67 $443.32 $509.82 $486.57 $559.55 $485.52 $558.35 $342.18 $393.50

37 $499.94 $574.93 $457.74 $526.40 $452.20 $520.03 $446.20 $513.13 $489.73 $563.19 $488.68 $561.98 $344.40 $396.06

38 $503.17 $578.65 $460.70 $529.80 $455.12 $523.39 $449.09 $516.45 $492.90 $566.83 $491.84 $565.61 $346.63 $398.62

39 $509.63 $586.08 $466.61 $536.60 $460.97 $530.11 $454.85 $523.08 $499.23 $574.11 $498.15 $572.88 $351.08 $403.74

40 $516.09 $593.51 $472.53 $543.41 $466.81 $536.83 $460.62 $529.71 $505.56 $581.39 $504.47 $580.14 $355.53 $408.86

41 $525.79 $604.65 $481.40 $553.61 $475.58 $546.91 $469.27 $539.66 $515.05 $592.31 $513.94 $591.04 $362.21 $416.54

42 $535.07 $615.34 $489.91 $563.39 $483.98 $556.57 $477.56 $549.19 $524.15 $602.77 $523.02 $601.48 $368.60 $423.90

43 $548.00 $630.20 $501.74 $577.00 $495.67 $570.02 $489.09 $562.46 $536.81 $617.33 $535.65 $616.00 $377.51 $434.13

44 $564.15 $648.77 $516.53 $594.01 $510.28 $586.82 $503.51 $579.04 $552.63 $635.53 $551.44 $634.16 $388.63 $446.93

45 $583.13 $670.60 $533.90 $613.99 $527.44 $606.56 $520.45 $598.52 $571.22 $656.91 $570.00 $655.50 $401.71 $461.97

46 $605.75 $696.61 $554.61 $637.80 $547.90 $630.08 $540.63 $621.73 $593.38 $682.38 $592.10 $680.92 $417.29 $479.88

47 $631.19 $725.86 $577.90 $664.59 $570.91 $656.55 $563.34 $647.84 $618.30 $711.04 $616.97 $709.52 $434.81 $500.04

48 $660.26 $759.30 $604.52 $695.20 $597.21 $686.79 $589.29 $677.68 $646.78 $743.80 $645.39 $742.20 $454.84 $523.07

49 $688.93 $792.27 $630.78 $725.39 $623.14 $716.62 $614.88 $707.11 $674.87 $776.10 $673.42 $774.43 $474.60 $545.79

50 $721.24 $829.43 $660.36 $759.41 $652.37 $750.22 $643.71 $740.27 $706.51 $812.49 $705.00 $810.75 $496.85 $571.38

51 $753.14 $866.11 $689.57 $793.00 $681.22 $783.40 $672.19 $773.02 $737.77 $848.43 $736.18 $846.61 $518.83 $596.65

52 $788.28 $906.52 $721.73 $829.99 $713.00 $819.95 $703.54 $809.08 $772.18 $888.01 $770.52 $886.10 $543.03 $624.49

53 $823.81 $947.39 $754.27 $867.41 $745.14 $856.91 $735.26 $845.55 $806.99 $928.04 $805.26 $926.05 $567.51 $652.64

54 $862.18 $991.50 $789.39 $907.80 $779.84 $896.82 $769.50 $884.93 $844.57 $971.26 $842.76 $969.17 $593.94 $683.03

55 $900.54 $1,035.62 $824.52 $948.20 $814.54 $936.73 $803.74 $924.30 $882.15 $1,014.48 $880.26 $1,012.30 $620.37 $713.42

56 $942.14 $1,083.46 $862.60 $991.99 $852.17 $979.99 $840.87 $967.00 $922.90 $1,061.33 $920.92 $1,059.05 $649.02 $746.38

57 $984.13 $1,131.75 $901.06 $1,036.21 $890.15 $1,023.68 $878.35 $1,010.10 $964.04 $1,108.65 $961.97 $1,106.26 $677.95 $779.65

58 $1,028.96 $1,183.30 $942.10 $1,083.41 $930.70 $1,070.30 $918.36 $1,056.11 $1,007.95 $1,159.14 $1,005.78 $1,156.65 $708.83 $815.16

59 $1,051.17 $1,208.84 $962.43 $1,106.80 $950.79 $1,093.41 $938.18 $1,078.91 $1,029.71 $1,184.16 $1,027.49 $1,181.62 $724.13 $832.75

60 $1,095.99 $1,260.39 $1,003.47 $1,154.00 $991.33 $1,140.03 $978.19 $1,124.91 $1,073.62 $1,234.66 $1,071.31 $1,232.01 $755.01 $868.27

61 $1,134.76 $1,304.98 $1,038.97 $1,194.81 $1,026.40 $1,180.36 $1,012.79 $1,164.71 $1,111.59 $1,278.33 $1,109.20 $1,275.58 $781.72 $898.98

62 $1,160.20 $1,334.23 $1,062.26 $1,221.60 $1,049.41 $1,206.82 $1,035.49 $1,190.82 $1,136.52 $1,306.99 $1,134.07 $1,304.18 $799.25 $919.13

63 $1,192.11 $1,370.92 $1,091.47 $1,255.19 $1,078.27 $1,240.01 $1,063.97 $1,223.56 $1,167.77 $1,342.93 $1,165.26 $1,340.04 $821.22 $944.41

64+ $1,211.48 $1,393.20 $1,109.21 $1,275.59 $1,095.79 $1,260.16 $1,081.26 $1,243.45 $1,186.74 $1,364.76 $1,184.19 $1,361.82 $834.57 $959.75

Pennsylvania Health & Wellness, Inc.

Individual

Ambetter

86199PA0010014

86199PA0010014

1/1/2020

86199PA0010005

86199PA0010012

December 31, 2020

$0 INT

50%

$45 Primary Care Visit to Treat an Injury or Illness (exc.

Preventive, and X-rays); $95 Specialist Visit; $45

Mental/Behavioral Health and Substance Use Disorder

Outpatient Services; $45 Laboratory Outpatient and

Professional Services; $36 Generic Drugs

$8,150

No

Ambetter Balanced Care 14 (2020)

86199

Rating Area 8

Ambetter

Silver

No

Ambetter Secure Care 5 (2020)

86199PA0010025 86199PA0010005 86199PA0010004

Ambetter

Gold

Rating Area 8

86199PA0010025





Professional Services; $15 Generic Drugs; $30 Preferred

Brand Drugs

$1250 INT

20%

$5,900

86199 8619986199

Silver

Ambetter

Rating Area 8Rating Area 8

NoNo




Outpatient Services; $20 Generic Drugs; $60 Preferred

Brand Drugs

0%

No

86199

Rating Area 8

$7,350

86199PA0010004

Ambetter

Silver

$6000 INT

40%






Brand Drugs

$8,100

86199PA0010012

$8,150

Ambetter Balanced Care 12 (2020)

$6500 INT

40%






Brand Drugs

Silver

Ambetter

$7350 INT

Ambetter Balanced Care 11 (2020)Ambetter Balanced Care 5 (2020)

86199PA0010015 86199PA0010002

86199PA0010015 86199PA0010002

86199 86199

Ambetter Balanced Care 15 (2020) Ambetter Essential Care 1 (2020)

Rating Area 8 Rating Area 8

Silver Bronze

Ambetter Ambetter

0%

$2950 INT $8150 INT






Brand Drugs

$20 Generic Drugs

40%

No No

$8,150 $8,150

RATE PAGES

Company Name:

Market:

Product:

Effective Date of Rates:




Form # =>

Rating Area =>

Network =>

Metal =>

Deductible =>

Coinsurance =>

Copays =>

OOP Maximum =>


Age Band

0 - 14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64+

Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco

$227.58 $227.58 $231.88 $231.88 $223.31 $223.31 $323.43 $323.43 $296.13 $296.13 $292.55 $292.55 $288.67 $288.67

$247.81 $247.81 $252.49 $252.49 $243.16 $243.16 $352.18 $352.18 $322.45 $322.45 $318.55 $318.55 $314.33 $314.33

$255.55 $255.55 $260.37 $260.37 $250.75 $250.75 $363.18 $363.18 $332.52 $332.52 $328.50 $328.50 $324.14 $324.14

$263.28 $263.28 $268.25 $268.25 $258.34 $258.34 $374.17 $374.17 $342.58 $342.58 $338.44 $338.44 $333.95 $333.95

$271.61 $312.35 $276.74 $318.25 $266.51 $306.49 $386.01 $443.91 $353.42 $406.44 $349.15 $401.52 $344.52 $396.19

$279.94 $321.93 $285.23 $328.01 $274.69 $315.89 $397.85 $457.52 $364.26 $418.90 $359.85 $413.83 $355.08 $408.34

$288.57 $331.85 $294.02 $338.12 $283.15 $325.63 $410.11 $471.62 $375.49 $431.81 $370.94 $426.59 $366.02 $420.93

$297.50 $342.13 $303.12 $348.59 $291.92 $335.71 $422.80 $486.22 $387.11 $445.18 $382.43 $439.79 $377.36 $433.96

$297.50 $342.13 $303.12 $348.59 $291.92 $335.71 $422.80 $486.22 $387.11 $445.18 $382.43 $439.79 $377.36 $433.96

$297.50 $342.13 $303.12 $348.59 $291.92 $335.71 $422.80 $486.22 $387.11 $445.18 $382.43 $439.79 $377.36 $433.96

$297.50 $342.13 $303.12 $348.59 $291.92 $335.71 $422.80 $486.22 $387.11 $445.18 $382.43 $439.79 $377.36 $433.96

$298.68 $343.49 $304.33 $349.97 $293.08 $337.04 $424.48 $488.15 $388.65 $446.95 $383.95 $441.54 $378.85 $435.68

$304.63 $350.33 $310.39 $356.95 $298.92 $343.75 $432.94 $497.88 $396.39 $455.85 $391.59 $450.33 $386.40 $444.36

$311.77 $358.54 $317.66 $365.31 $305.92 $351.81 $443.08 $509.55 $405.68 $466.53 $400.77 $460.89 $395.46 $454.78

$323.37 $371.88 $329.48 $378.91 $317.31 $364.90 $459.57 $528.51 $420.78 $483.89 $415.69 $478.04 $410.17 $471.70

$332.89 $382.83 $339.18 $390.06 $326.65 $375.64 $473.10 $544.07 $433.16 $498.14 $427.92 $492.11 $422.25 $485.59

$337.65 $388.30 $344.03 $395.64 $331.32 $381.02 $479.87 $551.85 $439.36 $505.26 $434.04 $499.15 $428.29 $492.53

$344.79 $396.51 $351.31 $404.00 $338.32 $389.07 $490.01 $563.52 $448.65 $515.95 $443.22 $509.70 $437.34 $502.94

$351.93 $404.72 $358.58 $412.37 $345.33 $397.13 $500.16 $575.19 $457.94 $526.63 $452.40 $520.26 $446.40 $513.36

$356.40 $409.86 $363.13 $417.60 $349.71 $402.16 $506.50 $582.48 $463.75 $533.31 $458.13 $526.85 $452.06 $519.87

$361.16 $415.33 $367.98 $423.18 $354.38 $407.54 $513.27 $590.26 $469.94 $540.43 $464.25 $533.89 $458.10 $526.81

$363.54 $418.07 $370.40 $425.96 $356.71 $410.22 $516.65 $594.15 $473.04 $543.99 $467.31 $537.41 $461.12 $530.28

$365.92 $420.80 $372.83 $428.75 $359.05 $412.91 $520.03 $598.04 $476.13 $547.55 $470.37 $540.93 $464.13 $533.75

$368.30 $423.54 $375.25 $431.54 $361.38 $415.59 $523.41 $601.93 $479.23 $551.11 $473.43 $544.45 $467.15 $537.23

$370.68 $426.28 $377.68 $434.33 $363.72 $418.28 $526.80 $605.82 $482.33 $554.68 $476.49 $547.96 $470.17 $540.70

$375.44 $431.75 $382.53 $439.91 $368.39 $423.65 $533.56 $613.60 $488.52 $561.80 $482.61 $555.00 $476.21 $547.64

$380.20 $437.23 $387.38 $445.48 $373.06 $429.02 $540.33 $621.38 $494.71 $568.92 $488.73 $562.04 $482.25 $554.58

$387.34 $445.44 $394.65 $453.85 $380.07 $437.08 $550.47 $633.04 $504.00 $579.60 $497.91 $572.59 $491.30 $565.00

$394.18 $453.30 $401.62 $461.87 $386.78 $444.80 $560.20 $644.23 $512.91 $589.84 $506.70 $582.71 $499.98 $574.98

$403.70 $464.25 $411.32 $473.02 $396.12 $455.54 $573.73 $659.79 $525.29 $604.09 $518.94 $596.78 $512.06 $588.87

$415.60 $477.94 $423.45 $486.97 $407.80 $468.97 $590.64 $679.23 $540.78 $621.90 $534.24 $614.37 $527.15 $606.22

$429.58 $494.02 $437.69 $503.35 $421.52 $484.75 $610.51 $702.09 $558.97 $642.82 $552.21 $635.04 $544.89 $626.62

$446.24 $513.18 $454.67 $522.87 $437.86 $503.54 $634.19 $729.31 $580.65 $667.75 $573.62 $659.67 $566.02 $650.92

$464.98 $534.73 $473.77 $544.83 $456.25 $524.69 $660.82 $759.94 $605.04 $695.79 $597.72 $687.37 $589.79 $678.26

$486.40 $559.36 $495.59 $569.93 $477.27 $548.86 $691.26 $794.95 $632.91 $727.84 $625.25 $719.04 $616.96 $709.50

$507.52 $583.65 $517.11 $594.68 $498.00 $572.70 $721.28 $829.47 $660.39 $759.45 $652.40 $750.26 $643.75 $740.31

$531.32 $611.02 $541.36 $622.56 $521.35 $599.55 $755.10 $868.37 $691.36 $795.06 $683.00 $785.44 $673.94 $775.03

$554.82 $638.05 $565.31 $650.10 $544.41 $626.07 $788.50 $906.78 $721.94 $830.23 $713.21 $820.19 $703.75 $809.31

$580.71 $667.81 $591.68 $680.43 $569.81 $655.28 $825.29 $949.08 $755.62 $868.96 $746.48 $858.45 $736.58 $847.06

$606.89 $697.92 $618.35 $711.10 $595.50 $684.82 $862.49 $991.87 $789.68 $908.14 $780.13 $897.15 $769.78 $885.25

$635.15 $730.42 $647.15 $744.22 $623.23 $716.71 $902.66 $1,038.06 $826.46 $950.43 $816.46 $938.93 $805.63 $926.48

$663.41 $762.92 $675.94 $777.33 $650.96 $748.60 $942.82 $1,084.25 $863.23 $992.72 $852.79 $980.71 $841.48 $967.70

$694.05 $798.16 $707.16 $813.24 $681.03 $783.18 $986.37 $1,134.33 $903.10 $1,038.57 $892.18 $1,026.00 $880.35 $1,012.40

$724.99 $833.74 $738.69 $849.49 $711.38 $818.09 $1,030.34 $1,184.89 $943.36 $1,084.87 $931.95 $1,071.74 $919.59 $1,057.53

$758.01 $871.71 $772.33 $888.18 $743.79 $855.35 $1,077.27 $1,238.86 $986.33 $1,134.28 $974.40 $1,120.56 $961.48 $1,105.70

$774.37 $890.53 $789.00 $907.35 $759.84 $873.82 $1,100.52 $1,265.60 $1,007.62 $1,158.76 $995.43 $1,144.74 $982.23 $1,129.56

$807.40 $928.50 $822.65 $946.05 $792.24 $911.08 $1,147.45 $1,319.57 $1,050.59 $1,208.18 $1,037.88 $1,193.56 $1,024.11 $1,177.73

$835.95 $961.35 $851.75 $979.51 $820.27 $943.31 $1,188.04 $1,366.25 $1,087.75 $1,250.91 $1,074.59 $1,235.78 $1,060.34 $1,219.39

$854.70 $982.90 $870.84 $1,001.47 $838.66 $964.46 $1,214.68 $1,396.88 $1,112.14 $1,278.96 $1,098.68 $1,263.48 $1,084.11 $1,246.73

$878.20 $1,009.93 $894.79 $1,029.01 $861.72 $990.98 $1,248.08 $1,435.29 $1,142.72 $1,314.13 $1,128.89 $1,298.23 $1,113.92 $1,281.01

$892.47 $1,026.34 $909.33 $1,045.73 $875.72 $1,007.08 $1,268.36 $1,458.62 $1,161.29 $1,335.49 $1,147.24 $1,319.33 $1,132.03 $1,301.83

86199PA0010024 86199PA0010006

86199PA0010022 86199PA0010024 86199PA0010006 86199PA0020025 86199PA0020005 86199PA0020004 86199PA0020012

86199PA0020025 86199PA0020005 86199PA0020004 86199PA002001286199PA0010022

86199 86199 86199 86199 86199 86199 86199

Ambetter Secure Care 5 (2020) + Vision + Adult Dental Ambetter Balanced Care 5 (2020) + Vision + Adult Dental Ambetter Balanced Care 11 (2020) + Vision + Adult Dental Ambetter Balanced Care 12 (2020) + Vision + Adult DentalAmbetter Essential Care 2 HSA (2020) Ambetter Essential Care 4 HSA (2020)

Rating Area 8 Rating Area 8Rating Area 8 Rating Area 8 Rating Area 8

Ambetter Essential Care 10 (2020)

Bronze Bronze Bronze

Ambetter Ambetter Ambetter Ambetter Ambetter Ambetter Ambetter

Rating Area 8 Rating Area 8

0% 30% 50%

$6750 INT $5400 INT $7200 INT $1250 INT $7350 INT $6000 INT $6500 INT

Gold Silver Silver Silver

$6,750 $8,150






Brand Drugs




Outpatient Services; $20 Generic Drugs; $60 Preferred

Brand Drugs






Brand Drugs






Brand Drugs

20% 0% 40% 40%

No No No No No No No

$5,900 $7,350 $8,100 $8,150$6,750

RATE PAGES

Company Name:

Market:

Product:

Effective Date of Rates:




Form # =>

Rating Area =>

Network =>

Metal =>

Deductible =>

Coinsurance =>

Copays =>

OOP Maximum =>


Age Band

0 - 14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64+

Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco Non-Tobacco Tobacco

$316.83 $316.83 $316.15 $316.15 $222.81 $222.81 $233.80 $233.80

$344.99 $344.99 $344.25 $344.25 $242.61 $242.61 $254.58 $254.58

$355.76 $355.76 $355.00 $355.00 $250.19 $250.19 $262.52 $262.52

$366.53 $366.53 $365.74 $365.74 $257.76 $257.76 $270.47 $270.47

$378.13 $434.85 $377.31 $433.91 $265.91 $305.80 $279.03 $320.88

$389.72 $448.18 $388.89 $447.22 $274.07 $315.18 $287.58 $330.72

$401.73 $461.99 $400.87 $461.00 $282.52 $324.89 $296.45 $340.91

$414.17 $476.29 $413.28 $475.27 $291.26 $334.95 $305.63 $351.47

$414.17 $476.29 $413.28 $475.27 $291.26 $334.95 $305.63 $351.47

$414.17 $476.29 $413.28 $475.27 $291.26 $334.95 $305.63 $351.47

$414.17 $476.29 $413.28 $475.27 $291.26 $334.95 $305.63 $351.47

$415.81 $478.19 $414.92 $477.16 $292.42 $336.28 $306.84 $352.86

$424.10 $487.71 $423.19 $486.66 $298.24 $342.98 $312.95 $359.89

$434.04 $499.14 $433.10 $498.07 $305.23 $351.02 $320.28 $368.33

$450.19 $517.72 $449.22 $516.61 $316.59 $364.08 $332.20 $382.03

$463.44 $532.96 $462.45 $531.81 $325.91 $374.80 $341.98 $393.28

$470.07 $540.58 $469.06 $539.42 $330.57 $380.16 $346.87 $398.90

$480.01 $552.01 $478.98 $550.82 $337.56 $388.20 $354.21 $407.34

$489.95 $563.44 $488.90 $562.23 $344.55 $396.24 $361.54 $415.77

$496.16 $570.59 $495.10 $569.36 $348.92 $401.26 $366.13 $421.05

$502.79 $578.21 $501.71 $576.96 $353.58 $406.62 $371.02 $426.67

$506.10 $582.02 $505.01 $580.77 $355.91 $409.30 $373.46 $429.48

$509.41 $585.83 $508.32 $584.57 $358.24 $411.98 $375.91 $432.29

$512.73 $589.64 $511.63 $588.37 $360.57 $414.66 $378.35 $435.10

$516.04 $593.45 $514.93 $592.17 $362.90 $417.34 $380.80 $437.92

$522.67 $601.07 $521.54 $599.78 $367.56 $422.70 $385.69 $443.54

$529.29 $608.69 $528.16 $607.38 $372.22 $428.06 $390.58 $449.16

$539.23 $620.12 $538.07 $618.79 $379.21 $436.09 $397.91 $457.60

$548.76 $631.07 $547.58 $629.72 $385.91 $443.80 $404.94 $465.68

$562.01 $646.31 $560.80 $644.93 $395.23 $454.52 $414.72 $476.93

$578.58 $665.37 $577.34 $663.94 $406.88 $467.91 $426.94 $490.99

$598.04 $687.75 $596.76 $686.27 $420.57 $483.66 $441.31 $507.51

$621.24 $714.42 $619.90 $712.89 $436.88 $502.41 $458.42 $527.19

$647.33 $744.43 $645.94 $742.83 $455.23 $523.51 $477.68 $549.33

$677.15 $778.72 $675.69 $777.05 $476.20 $547.63 $499.68 $574.63

$706.55 $812.54 $705.04 $810.79 $496.88 $571.41 $521.38 $599.59

$739.69 $850.64 $738.10 $848.81 $520.18 $598.21 $545.83 $627.70

$772.41 $888.27 $770.74 $886.36 $543.19 $624.67 $569.97 $655.47

$808.44 $929.70 $806.70 $927.70 $568.53 $653.81 $596.56 $686.05

$844.88 $971.62 $843.07 $969.53 $594.16 $683.28 $623.46 $716.97

$884.23 $1,016.86 $882.33 $1,014.68 $621.83 $715.10 $652.49 $750.36

$923.57 $1,062.11 $921.59 $1,059.83 $649.50 $746.92 $681.52 $783.75

$966.23 $1,111.17 $964.15 $1,108.78 $679.50 $781.42 $713.00 $819.95

$1,009.30 $1,160.70 $1,007.13 $1,158.20 $709.79 $816.25 $744.78 $856.50

$1,055.28 $1,213.57 $1,053.01 $1,210.96 $742.12 $853.43 $778.71 $895.51

$1,078.05 $1,239.76 $1,075.74 $1,237.10 $758.13 $871.85 $795.52 $914.84

$1,124.03 $1,292.63 $1,121.61 $1,289.85 $790.46 $909.03 $829.44 $953.86

$1,163.78 $1,338.35 $1,161.28 $1,335.48 $818.42 $941.19 $858.78 $987.60

$1,189.88 $1,368.36 $1,187.32 $1,365.42 $836.77 $962.29 $878.03 $1,009.74

$1,222.60 $1,405.98 $1,219.97 $1,402.96 $859.78 $988.75 $902.18 $1,037.50

$1,242.46 $1,428.84 $1,239.79 $1,425.76 $873.75 $1,004.82 $916.84 $1,054.36

86199PA0020015 86199PA0020002 86199PA0020006

86199PA0020014 86199PA0020015 86199PA0020002 86199PA0020006

86199PA0020014

Ambetter Essential Care 1 (2020) + Vision + Adult Dental Ambetter Essential Care 10 (2020) + Vision + Adult Dental

86199 86199 86199 86199

Ambetter Balanced Care 14 (2020) + Vision + Adult Dental

Rating Area 8

Ambetter Balanced Care 15 (2020) + Vision + Adult Dental

Silver

Rating Area 8 Rating Area 8 Rating Area 8

Ambetter Ambetter Ambetter Ambetter

Silver Bronze Bronze

$0 INT $2950 INT $8150 INT $7200 INT

40% 0% 50%





Professional Services; $36 Generic Drugs






Brand Drugs

$20 Generic Drugs

50%

$8,150 $8,150 $8,150

No No No No

$8,150

HIOS Plan ID Plan Marketing Name Product Metal

On/Off

Exchange Network Rating Area Counties Covered

86199PA0010025 Ambetter Secure Care 5 (2020) HMO Gold On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia

86199PA0010005 Ambetter Balanced Care 5 (2020) HMO Silver On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia





86199PA0010002 Ambetter Essential Care 1 (2020) HMO Bronze On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia

86199PA0010022 Ambetter Essential Care 2 HSA (2020) HMO Bronze On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia

86199PA0010024 Ambetter Essential Care 4 HSA (2020) HMO Bronze On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia

86199PA0010006 Ambetter Essential Care 10 (2020) HMO Bronze On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia

86199PA0020025 Ambetter Secure Care 5 (2020) + Vision + Adult Dental HMO Gold On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia

86199PA0020005 Ambetter Balanced Care 5 (2020) + Vision + Adult Dental HMO Silver On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia





86199PA0020002 Ambetter Essential Care 1 (2020) + Vision + Adult Dental HMO Bronze On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia

86199PA0020006 Ambetter Essential Care 10 (2020) + Vision + Adult Dental HMO Bronze On Ambetter Rating Area 8 Bucks, Montgomery, Philadelphia


Individual

Plan Design Summary

Company Name Pennsylvania Health & Wellness, Inc.

Market Individual

RATES FOR AGE 21, NON-TOBACCO USER, BY RATING AREA AND COUNTY

RATING AREA 1 RATING AREA 2 RATING AREA 3

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

HIOS Plan ID Plan Marketing Name Product Metal

On/Off

Exchange Crawford Clarion Erie Forest Mckean Mercer Venango Warren Elk Cameron Potter Bradford Carbon Clinton Lackawanna Luzerne Lycoming Monroe Pike Sullivan Susquehanna Tioga Wayne Wyoming

86199PA0010025 Ambetter Secure Care 5 (2020) HMO Gold On

86199PA0010005 Ambetter Balanced Care 5 (2020) HMO Silver On





86199PA0010002 Ambetter Essential Care 1 (2020) HMO Bronze On

86199PA0010022 Ambetter Essential Care 2 HSA (2020) HMO Bronze On

86199PA0010024 Ambetter Essential Care 4 HSA (2020) HMO Bronze On

86199PA0010006 Ambetter Essential Care 10 (2020) HMO Bronze On

86199PA0020025 Ambetter Secure Care 5 (2020) + Vision + Adult Dental HMO Gold On

86199PA0020005 Ambetter Balanced Care 5 (2020) + Vision + Adult Dental HMO Silver On





86199PA0020002 Ambetter Essential Care 1 (2020) + Vision + Adult Dental HMO Bronze On

86199PA0020006 Ambetter Essential Care 10 (2020) + Vision + Adult Dental HMO Bronze On

02-01-2019 Number of Covered Lives by Rating County


0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Allegheny Armstrong Beaver Butler Fayette Greene Indiana Lawrence Washington Westmoreland Bedford Blair Clearfield Cambria Huntingdon Jefferson Somerset Centre Columbia Lehigh Mifflin Montour Northampton Northumberland Schuylkill Snyder Union


0 0 0 0 357 0 0 360 1,152 0 0 0 0 0 0 0

Adams Berks Lancaster York Bucks Chester Delaware Montgomery Philadelphia Cumberland Dauphin Franklin Fulton Juniata Lebanon Perry

$403.84 $403.84 $403.84

$369.75 $369.75 $369.75

$365.28 $365.28 $365.28

$360.43 $360.43 $360.43

$395.59 $395.59 $395.59

$394.74 $394.74 $394.74

$278.20 $278.20 $278.20

$297.50 $297.50 $297.50

$303.12 $303.12 $303.12

$291.92 $291.92 $291.92

$422.80 $422.80 $422.80

$387.11 $387.11 $387.11

$382.43 $382.43 $382.43

$377.36 $377.36 $377.36

$414.17 $414.17 $414.17

$413.28 $413.28 $413.28

$291.26 $291.26 $291.26

$305.63 $305.63 $305.63

BlairCambria

HuntingdonWestmoreland

ClearfieldCentre

CumberlandLancaster

Lebanon

Dauphin

Schuylkill

Carbon

Cameron

York

Adams

Franklin

Juniata

Mifflin

Northumberland

Columbia

Montour

Luzerne

Lackawanna

Lehigh

DelawareFulton

Allegheny

Washington

Butler

Lawrence

Erie

Armstrong

Beaver

Bedford

Berks

Bradford

Bucks

Chester

Clarion Clinton

Crawford

Elk

Fayette

Forest

Greene

Indiana

Jefferson

Lycoming

Mckean

Mercer

Monroe

Montgomery

Northampton

Perry

Philadelphia

Pike

Potter

Snyder

Somerset

Sullivan

SusquehannaTioga

Union

Venango

Warren

Wayne

Wyoming

Issuer: Pennsylvania Health & Wellness, Inc.Market: Individual

Key:: On-exchange service area (2019 & 2020): Off-exchange service area (2019 & 2020)

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A B C D E F G H I J K L M N O P Q R

If

mUnified Rate Review v5.0 To add a product to Worksheet 2 - Plan Product Info, select the Add Product button or Ctrl + Shift + P.

To add a plan to Worksheet 2 - Plan Product Info, select the Add Plan button or Ctrl + Shift + L.

Company Legal Name: Pennsylvania Health & Wellness, Inc. State: PA To validate, select the Validate button or Ctrl + Shift + I.

HIOS Issuer ID: 86199 Market: Individual To finalize, select the Finalize button or Ctrl + Shift + F.

Effective Date of Rate Change(s): 1/1/2020

Section I: Experience Period Data

Experience Period: 1/1/2018 to 12/31/2018

Total PMPM

$0.00 #DIV/0!

$0.00 #DIV/0!

$0.00 #DIV/0!

$0.00 #DIV/0!

$0.00 #DIV/0!

0

Section II: Projections

Cost Utilization Cost Utilization

Inpatient Hospital $0.00 1.000 1.000 1.000 1.000 $0.00

Outpatient Hospital $0.00 1.000 1.000 1.000 1.000 $0.00

Professional $0.00 1.000 1.000 1.000 1.000 $0.00

Other Medical $0.00 1.000 1.000 1.000 1.000 $0.00

Capitation $0.00 1.000 1.000 1.000 1.000 $0.00

Prescription Drug $0.00 1.000 1.000 1.000 1.000 $0.00

Total $0.00 $0.00

1.000

1.000

1.000

1.000

1/1/2020 $0.00

$537.19

0.00%

Projected Period Totals

1/1/2020 $537.19 $60,180,858.51

$0.00 $0.00

-$66.48 -$7,447,687.92

3.44% $2,409,301.99

$625.18 $70,037,848.42

112,029

Other

Adjusted Trended EHB Allowed Claims PMPM for

Morbidity Adjustment

Information Not Releasable to the Public Unless Authorized by Law: This information has not been publically disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full

extent of the law.

Projected Member Months

Projected Index Rate for

Reinsurance


Exchange User Fees

Market Adjusted Index Rate

Applied Credibility %

Manual EHB Allowed Claims PMPM

Demographic Shift

Plan Design Changes

Market Level Calculations (Same for all Plans)

Trended EHB Allowed Claims

PMPM

Year 1 Trend Year 2 Trend

Allowed Claims

Reinsurance

Incurred Claims in Experience Period

Risk Adjustment

Experience Period Premium

Experience Period Member Months

Benefit Category

Experience Period Index

Rate PMPM

1 of 3

If macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells P1 through P4.Product-Plan Data Collection To add a product to Worksheet 2 - Plan Product Info, select the Add Product button or Ctrl + Shift + P.

To add a plan to Worksheet 2 - Plan Product Info, select the Add Plan button or Ctrl + Shift + L.

Company Legal Name: Pennsylvania Health & Wellness, Inc. State: PA To validate, select the Validate button or Ctrl + Shift + I.

HIOS Issuer ID: 86199 Market: Individual To finalize, select the Finalize button or Ctrl + Shift + F.

Effective Date of Rate Change(s): 1/1/2020

Field # Section I: General Product and Plan Information

1.1 Product Name

1.2 Product ID

1.3 Plan Name

Ambetter

Essential Care 1

(2020)

Ambetter

Essential Care 2

HSA (2020)

Ambetter

Essential Care 4

HSA (2020)

Ambetter

Essential Care 10

(2020)

Ambetter

Balanced Care 5

(2020)

Ambetter

Balanced Care 11

(2020)

Ambetter

Balanced Care 12

(2020)

Ambetter

Balanced Care 3

(2019)

Ambetter

Balanced Care 14

(2020)

Ambetter

Balanced Care 15

(2020)

Ambetter Secure

Care 1 (2019) with

3 Free PCP Visits

Ambetter Secure

Care 5 (2020)

Ambetter

Essential Care 1

(2020) + Vision +

Adult Dental

Ambetter

Essential Care 10

(2020) + Vision +

Adult Dental

Ambetter

Balanced Care 5

(2020) + Vision +

Adult Dental

Ambetter

Balanced Care 11

(2020) + Vision +

Adult Dental

Ambetter

Balanced Care 12

(2020) + Vision +

Adult Dental

Ambetter

Balanced Care 14

(2020) + Vision +

Adult Dental

Ambetter

Balanced Care 15

(2020) + Vision +

Adult Dental

Ambetter Secure

Care 5 (2020) +

Vision + Adult

Dental

1.4 Plan ID (Standard Component ID) 86199PA0010002 86199PA0010022 86199PA0010024 86199PA0010006 86199PA0010005 86199PA0010004 86199PA0010012 86199PA0010003 86199PA0010014 86199PA0010015 86199PA0010001 86199PA0010025 86199PA0020002 86199PA0020006 86199PA0020005 86199PA0020004 86199PA0020012 86199PA0020014 86199PA0020015 86199PA0020025

1.5 Metal Bronze Bronze Bronze Bronze Silver Silver Silver Silver Silver Silver Gold Gold Bronze Bronze Silver Silver Silver Silver Silver Gold

1.6 AV Metal Value 0.603 0.625 0.632 0.638 0.690 0.695 0.680 0.718 0.715 0.720 0.804 0.817 0.603 0.638 0.690 0.695 0.680 0.715 0.720 0.817

1.7 Plan Category Renewing New New New Renewing Renewing New Terminated New New Terminated New New New New New New New New New

1.8 Plan Type HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO HMO

1.9 Exchange Plan? Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes

1.10 Effective Date of Proposed Rates 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020 1/1/2020

1.11 Cumulative Rate Change % (over 12 mos prior) -5.03% 0.00% 0.00% 0.00% 0.09% 0.39% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

1.12 Product Rate Increase %

1.13 Submission Level Rate Increase %

Worksheet 1 Totals Section II: Experience Period and Current Plan Level Information

2.1 Plan ID (Standard Component ID) Total 86199PA0010002 86199PA0010022 86199PA0010024 86199PA0010006 86199PA0010005 86199PA0010004 86199PA0010012 86199PA0010003 86199PA0010014 86199PA0010015 86199PA0010001 86199PA0010025 86199PA0020002 86199PA0020006 86199PA0020005 86199PA0020004 86199PA0020012 86199PA0020014 86199PA0020015 86199PA0020025

$0 2.2 Allowed Claims $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 2.3 Reinsurance $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

2.4 Member Cost Sharing $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

2.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 2.6 Incurred Claims $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 2.7 Risk Adjustment Transfer Amount $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

$0 2.8 Premium $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

0 2.9 Experience Period Member Months 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2.10 Current Enrollment 1,869 646 0 0 0 192 990 0 17 0 0 24 0 0 0 0 0 0 0 0 0

2.11 Current Premium PMPM $599.39 $577.83 $0.00 $0.00 $0.00 $637.10 $604.31 $0.00 $701.97 $0.00 $0.00 $602.20 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

2.12 Loss Ratio #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Per Member Per Month

2.13 Allowed Claims #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

2.14 Reinsurance #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

2.15 Member Cost Sharing #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

2.16 Cost Sharing Reduction #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

2.17 Incurred Claims #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

2.18 Risk Adjustment Transfer Amount #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

2.19 Premium #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

Section III: Plan Adjustment Factors

3.1 Plan ID (Standard Component ID) 86199PA0010002 86199PA0010022 86199PA0010024 86199PA0010006 86199PA0010005 86199PA0010004 86199PA0010012 86199PA0010003 86199PA0010014 86199PA0010015 86199PA0010001 86199PA0010025 86199PA0020002 86199PA0020006 86199PA0020005 86199PA0020004 86199PA0020012 86199PA0020014 86199PA0020015 86199PA0020025

3.2 Market Adjusted Index Rate

3.3 AV and Cost Sharing Design of Plan 0.6743 0.7211 0.7347 0.7075 0.8962 0.8853 0.8736 0.0000 0.9588 0.9567 0.0000 0.9788 0.6743 0.7075 0.8962 0.8853 0.8736 0.9588 0.9567 0.9788

3.4 Provider Network Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

3.5 Benefits in Addition to EHB 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0470 1.0470 1.0470 1.0470 1.0470 1.0470 1.0470 1.0470

Administrative Costs

3.6 Administrative Expense 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86% 7.86%

3.7 Taxes and Fees 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23% 3.23%

3.8 Profit & Risk Load 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75% 1.75%

3.9 Catastrophic Adjustment 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000 1.0000

3.10 Plan Adjusted Index Rate $483.66 $517.23 $526.98 $507.47 $642.82 $635.00 $626.61 $0.00 $687.72 $686.22 $0.00 $702.07 $506.39 $531.32 $673.03 $664.85 $656.06 $720.05 $718.47 $735.07

3.11 Age Calibration Factor 0.5784

3.12 Geographic Calibration Factor 1.0000

3.13 Tobacco Calibration Factor 0.9944

3.14 Calibrated Plan Adjusted Index Rate $278.18 $297.49 $303.10 $291.88 $369.73 $365.23 $360.40 $0.00 $395.55 $394.68 $0.00 $403.80 $291.26 $305.60 $387.10 $382.39 $377.34 $414.14 $413.23 $422.78

Section IV: Projected Plan Level Information

4.1 Plan ID (Standard Component ID) Total 86199PA0010002 86199PA0010022 86199PA0010024 86199PA0010006 86199PA0010005 86199PA0010004 86199PA0010012 86199PA0010003 86199PA0010014 86199PA0010015 86199PA0010001 86199PA0010025 86199PA0020002 86199PA0020006 86199PA0020005 86199PA0020004 86199PA0020012 86199PA0020014 86199PA0020015 86199PA0020025

4.2 Allowed Claims $60,372,694 $7,517,233 $5,902 $2,964,096 $7,524,297 $5,129,014 $18,014,031 $12,581,670 $0 $1,826,282 $23,577 $0 $729,769 $549,709 $550,428 $395,714 $1,389,962 $974,326 $140,872 $2,251 $53,563

4.3 Reinsurance $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

4.4 Member Cost Sharing $10,829,563 $2,278,284 $1,330 $840,297 $2,306,917 $527,576 $2,350,906 $1,453,300 $0 $287,400 $3,886 $0 $81,121 $162,953 $165,006 $42,038 $184,426 $115,311 $22,316 $373 $6,125

4.5 Cost Sharing Reduction $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0

4.6 Incurred Claims $49,543,131 $5,238,949 $4,572 $2,123,799 $5,217,380 $4,601,438 $15,663,125 $11,128,370 $0 $1,538,882 $19,691 $0 $648,648 $386,755 $385,422 $353,676 $1,205,537 $859,016 $118,557 $1,878 $47,438

4.7 Risk Adjustment Transfer Amount -$6,112,903 -$815,882 -$621 -$307,954 -$815,377 -$476,718 -$1,779,963 -$1,094,527 $0 -$227,527 -$3,218 $0 -$199,917 -$56,470 -$56,460 -$35,151 -$131,169 -$80,969 -$16,705 -$293 -$13,982

4.8 Premium $66,142,543 $7,658,611 $6,206 $3,147,102 $8,032,696 $5,692,732 $20,061,320 $13,756,012 $0 $2,369,963 $30,196 $0 $943,593 $554,975 $582,340 $439,468 $1,547,783 $1,065,407 $182,170 $2,874 $69,095

4.9 Projected Member Months 112,029 15,835 12 5,972 15,828 8,856 31,591 21,953 0 3,446 44 0 1,344 1,096 1,096 653 2,328 1,624 253 4 94

4.10 Loss Ratio 82.53% 76.56% 81.84% 74.80% 72.29% 88.22% 85.68% 87.89% #DIV/0! 71.83% 72.99% #DIV/0! 87.22% 77.58% 73.29% 87.47% 85.10% 87.26% 71.65% 72.76% 86.07%

Per Member Per Month

4.11 Allowed Claims $538.90 $474.72 $491.81 $496.33 $475.38 $579.16 $570.23 $573.12 #DIV/0! $529.97 $535.85 #DIV/0! $542.98 $501.56 $502.22 $605.99 $597.06 $599.95 $556.81 $562.68 $569.82

4.12 Reinsurance $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 #DIV/0! $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

4.13 Member Cost Sharing $96.67 $143.88 $110.84 $140.71 $145.75 $59.57 $74.42 $66.20 #DIV/0! $83.40 $88.32 #DIV/0! $60.36 $148.68 $150.55 $64.38 $79.22 $71.00 $88.20 $93.13 $65.16

4.14 Cost Sharing Reduction $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 #DIV/0! $0.00 $0.00 #DIV/0! $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00

4.15 Incurred Claims $442.23 $330.85 $380.97 $355.63 $329.63 $519.58 $495.81 $506.92 #DIV/0! $446.57 $447.52 #DIV/0! $482.63 $352.88 $351.66 $541.62 $517.84 $528.95 $468.60 $469.56 $504.66

4.16 Risk Adjustment Transfer Amount -$54.57 -$51.52 -$51.72 -$51.57 -$51.51 -$53.83 -$56.34 -$49.86 #DIV/0! -$66.03 -$73.13 #DIV/0! -$148.75 -$51.52 -$51.51 -$53.83 -$56.34 -$49.86 -$66.03 -$73.13 -$148.75

4.17 Premium $590.41 $483.65 $517.21 $526.98 $507.50 $642.81 $635.03 $626.61 #DIV/0! $687.74 $686.26 #DIV/0! $702.08 $506.36 $531.33 $673.00 $664.86 $656.04 $720.04 $718.49 $735.05

1.0000

0.9944

$625.18

Product/Plan Level Calculations

Ambetter

86199PA001

-1.50%

Ambetter + Vision + Adult Dental

86199PA002

0.00%

-1.50%

0.5784

Rating Area Data CollectionIf macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells C1 through C4.

Rating Area Rating Factor

Rating Area 8 1.0000

Part II: Written Justification of Rate Increase


Individual Rate Filing

Effective: January 1, 2020

Forms: 86199PA001, 86199PA002

PHW is filing rates for the individual block of business, effective January 1, 2020. Thisdocument is submitted in conjunction with the Part I Unified Rate Review Template andthe Part III Actuarial Memorandum.

This information is intended for use by the Pennsylvania Insurance Department, theCenter for Consumer Information and Insurance Oversight (CCIIO), and healthinsurance consumers in Pennsylvania to assist in the review of PHW’s individual ratefiling.

The results are actuarial projections. Actual experience will differ for a number ofreasons, including population changes, claims experience, and random deviations fromassumptions.

PHW filed rates for the individual block of business in the State of Pennsylvania for thefirst time in 2019, so there is no experience in 2018. We expect unit costs to increasefor 2020. Further, we have updated experience underlying the manual rate for the singlerisk pool, expected administrative expense, and assumptions for federal riskadjustment. These factors, as well as changes to the assumed morbidity of the singlerisk pool and medical trend, each contribute to the premium rate change.

There was a moratorium on the ACA Insurer fee for 2019, but this moratorium is notslated to continue into 2020. This increases non-benefit expenses for all plans andrating areas.

Medical trend, or the increase in health care costs over time, is composed of twocomponents: the increase in the unit cost of services and the increase in the utilizationof those services. Unit cost increases occur as care providers and their suppliers raisetheir prices. Utilization increases can occur as people seek more services than before.Additionally, simple services can be replaced with more complex services over time,which is known as service intensity trend. An example of service intensity trend wouldbe the replacement of an X-ray with an MRI scan. Replacing the service with a moreintense service causes the total cost of medical services to increase.

Whether the government reimburses cost-sharing amounts for lower income individualsgreatly impacts the rates. Both 2019 and 2020 rate levels assume that there will be nofunding of cost-sharing reduction subsidies.

The proposed rate change of -1.5% applies to approximately 1,869 individuals. PHW’sprojected administrative expenses for 2020 are $41.51 PMPM, or 7.0% of premium.

Administrative expense does not include $31.98 for taxes and fees. The historicaladministrative expenses are not available, as this product was new with 1/1/2019. Theprojected loss ratio is 90.6%, which satisfies the federal minimum loss ratio requirementof 80.0%.

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Part III: Actuarial Memorandum

[Redacted]


Annual Individual Health Rate Filing

Pennsylvania

Effective January 1, 2020

Forms: 86199PA001, 86199PA002

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TABLE OF CONTENTS

1. GENERAL INFORMATION ..................................................................................................................................... 3

2. PROPOSED RATE CHANGES .............................................................................................................................. 6

3. SINGLE RISK POOL ............................................................................................................................................... 8

4. EXPERIENCE AND CURRENT PERIOD PREMIUM, CLAIMS, AND ENROLLMENT ..................................... 9

5. BENEFIT CATEGORIES ....................................................................................................................................... 10

6. TREND FACTORS ................................................................................................................................................. 11

7. ADJUSTMENTS TO TRENDED EHB ALLOWED CLAIMS PMPM .................................................................. 12

8. MANUAL RATE ADJUSTMENTS ........................................................................................................................ 13

9. CREDIBILITY OF EXPERIENCE ......................................................................................................................... 15

10. ESTABLISHING THE INDEX RATE .................................................................................................................... 16

11. DEVELOPMENT OF MARKET-WIDE ADJUSTED INDEX RATE .................................................................... 17

12. PLAN ADJUSTED INDEX RATE ........................................................................................................................ 20

13. CALIBRATION ...................................................................................................................................................... 23

14. CONSUMER ADJUSTED PREMIUM RATE DEVELOPMENT ........................................................................ 24

15. PROJECTED LOSS RATIO ................................................................................................................................. 25

16. AV METAL VALUES ............................................................................................................................................ 26

17. MEMBERSHIP PROJECTIONS .......................................................................................................................... 27

18. TERMINATED PLANS AND PRODUCTS .......................................................................................................... 28

19. PLAN TYPE ........................................................................................................................................................... 29

20. EFFECTIVE RATE REVIEW INFORMATION .................................................................................................... 30

21. RELIANCE ............................................................................................................................................................. 31

22. ACTUARIAL CERTIFICATION ............................................................................................................................ 32

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1. General Information

Scope and Purpose

This document contains the Part III Actuarial Memorandum for the individual health rate filingsubmitted by Pennsylvania Health & Wellness, Inc. (PHW) in the state of Pennsylvania,effective January 1, 2020. This actuarial memorandum is submitted in conjunction with the PartI Unified Rate Review Template (URRT) and Part II Written Justification. This is a renewal ratefiling.

The purpose of the actuarial memorandum is to provide certain information related to thesubmission, including support for the values entered into the Part I URRT, which supportscompliance with market rating rules and reasonableness of applicable rates. This informationmay not be appropriate for other purposes.

This information is intended for use by the Pennsylvania Insurance Department, the Center forConsumer Information and Insurance Oversight (CCIIO), and their subcontractors to assist inthe review of PHW’s individual rate filing. However, we recognize that this certification maybecome a public document. Milliman makes no representations or warranties regarding thecontents of this letter to other users. Likewise, other users of this letter should not placereliance upon this actuarial memorandum that would result in the creation of any duty orliability for Milliman or its employees under any theory of law.

Consistent with the October 12, 2017 payment memo from the U.S. Department of Health andHuman Services (HHS)1, the premium rates developed and supported by this ActuarialMemorandum assume that cost-sharing reduction (CSR) subsidies will not be funded. Futuremodifications in legislation, appropriations, regulation, and/or court decisions regarding thefunding of CSR payments may affect the extent to which the premium rates are neitherexcessive nor deficient.

As instructed by PHW, the premium rates developed and supported by this ActuarialMemorandum are based on legislative and regulatory provisions in effect at the time ofsubmission. Changes to these provisions that impact 2020 may affect the extent to which thepremium rates are sufficient and neither excessive nor deficient. PHW reserves the right to filerevised rates in the event of changes to the regulatory environment in which they weredeveloped to ensure rates are appropriate.

In addition to CSR payments, material rating impacts could arise from changes to variousfactors, including but not limited to:

· Advanced Premium Tax Credits· Risk adjustment program payments and operation

· Limit on age rating factors· Legal challenges to provisions of the Patient Protection and Affordable Care Act (ACA)

· Open enrollment duration and grace period modifications

1 https://www.hhs.gov/sites/default/files/csr-payment-memo.pdf

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· Status and implementation of Medicaid Expansion

· Enrollment of other populations (Medicare, Medicaid, high risk pool)· Non-QHP coverage options (e.g. association health plans, short-term limited-duration

insurance)· Rules for Health Savings Accounts and Health Reimbursement Arrangements· 1332 Waivers (e.g. state-based reinsurance programs)

· Pharmacy (e.g. rules concerning mid-year formulary changes, pharmacy rebates, andtreatment of cost sharing)

· Taxes and fees

If there are material deviations in the state-wide average premium (SWAP) for 2020 – forexample, based on changes in the number of carriers in the market or carriers’ pricingassumptions for 2020 - we would like to work with the Pennsylvania Insurance Departmentafter the initial submission to update our estimated risk adjustment transfer.

The results are actuarial projections. Actual results will vary from those projected in the filingfor a number of reasons, including population changes, claims experience, and randomdeviations from assumptions.

Company Identifying Information

· Company Legal Name: Pennsylvania Health & Wellness, Inc.

· State: The State of Pennsylvania has regulatory authority over these policies.

· HIOS Issuer ID: 86199

· Market: Individual

· Effective Date: January 1, 2020

Company Contact Information

· Primary Contact Name: '''''''''''''''''''''''' ''''''''''''

· Primary Contact Telephone Number: '''''''''''' ''''''''''''''''''''''

· Primary Contact Email Address: '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

Description of Benefits

These products are issued by PHW as HMO health policies.

The major provisions of this form for each plan design and product can be found in Appendix1.1.

Rate Guarantees

Rates are guaranteed not to change through December 31, 2020.

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Renewability

Each policy is renewable by paying the applicable renewal premiums unless the policy holderno longer meets the eligibility requirements of the policy or the company decides not to renewall the policies in the state.

Applicability

The rates will apply to new and renewing business.

General Marketing Method

This product will be sold through agents, direct mailings, the internet, and the Federally-facilitated Exchange.

Estimated Average Annual Premium

The estimated average annual premium per policy in calendar year 2020 is $7,085.

Distribution of Business

See Appendix 1.2 for the expected age and geographic distributions for these products.

Rate Tables

See Appendix 1.3 for allowable rating factors. Appendix 1.4 also includes an example of howrating factors will be applied. For family coverage, rates for children are charged to no morethan the three oldest covered children under age 21 consistent with the ACA.

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2. Proposed Rate Changes

The rate changes for each product offered in the single risk pool by PHW in the State ofPennsylvania are reflected in Worksheet 2, Section I of the Part I URRT.

Reasons for Rate Increase(s):

The rate projections for 2020 have been updated from the previous year’s projections to reflectthe most recent information available.

The following provides a narrative description of the significant factors driving the proposedrate change for 2020. Appendix 2.1 provides quantitative support for the proposed ratechanges.

· Unit Cost trend

Expected unit cost levels and reimbursement arrangements with providers havechanged between 2019 and 2020.

· Utilization trend

The Milliman Health Cost Guidelines underlying the rate projections have been updated.The current model reflects the projected utilization trend from 2019 to 2020. There is afull description of the Health Cost Guidelines in Section 8, “Manual Rate Adjustments”.

· Prospective changes to benefits covered by the product or successor products

The benefits covered are not expected to change between 2019 and 2020 plan years.

· Taxes and fees imposed on the issuer

Premium rates have been adjusted to reflect the schedule of taxes and fees for 2020.For 2019, there was a moratorium on the ACA Insurer Fee. This moratorium is notslated to continue into 2020. This increases rates relative to 2019.

· Anticipated changes in the average morbidity of the single risk pool

The 2020 projection of morbidity reflects a restatement of the 2019 enrollment andmorbidity projection based on emerging information plus the projected impact of newenrollment into the risk pool from 2019 to 2020 on the risk pool. There is a fulldescription of the morbidity assumption in Section 8, “Manual Rate Adjustments”.

· Non-funding of cost-sharing reduction (CSR) subsidies

Premium rates continue to reflect that PHW will not be reimbursed by the U.S.Department of Health and Human Services (HHS) for cost-sharing on CSR Silver plans.Enrollment projections reflect updated expectations regarding member plan selectionsby metal and CSR level, which in turn affect the required rate load to compensate forCSR non-funding.

7

The variance in the rate changes across plans does not reflect the incorporation of plan-specific morbidity. When projecting plan rating factors, we have assumed the samedemographic and risk characteristics for each plan priced. This pricing method excludesexpected differences in the morbidity of members assumed to select the plan. Additionaldiscussion of how the actuarial value of each plan is determined can be found in Section 12,“Plan Adjusted Index Rate”, which further addresses how rate changes can vary by plan undera single risk pool methodology.

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3. Single Risk Pool

The 2020 rate development is based on the single risk pool set by the State of Pennsylvania,which was established according to the requirements in 45 CFR Part 156.80. The single riskpool is defined as the non-grandfathered individual business in Pennsylvania.

The single risk pool for the projection period does not include members who are eligible toremain enrolled in transitional plans.

9

4. Experience and Current Period Premium, Claims, andEnrollment

Not applicable. This product was first offered in 2019 and, therefore, has no 2018 experienceto report.

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5. Benefit Categories

The Milliman Health Cost Guidelines (HCGs) were used to categorize the projected claims intothe benefit categories in Worksheet 1, Section II. The detailed benefit categories from theHCGs were then consolidated into the URRT benefit categories shown on Worksheet 1,Section II of the Part I URRT. See Appendix 5.1 for a description of this mapping.

The algorithm used to assign the experience and manual data utilization and cost informationis summarized as follows:

Inpatient Hospital

Inpatient hospital includes non-capitated facility services for medical, surgical, maternity,mental health and substance abuse, skilled nursing, and other services provided in aninpatient facility setting and billed by the facility.

Outpatient Hospital

Outpatient hospital includes non-capitated facility services for surgery, emergency room, lab,radiology, therapy, observation, and other services provided in an outpatient facility setting andbilled by the facility.

Professional

Professional includes non-capitated primary care, specialist, therapy, the professionalcomponent of laboratory and radiology, and other professional services other than hospitalbased professionals whose payments are included in facility fees.

Other Medical

Other medical includes non-capitated ambulance, home health care, DME, prosthetics,supplies, vision exams, dental services, and other services. The measurement units forutilization used in this category are a mix of visits, cases, procedures, etc.

Capitation

Capitation includes all services provided under one or more capitated arrangements.

Prescription Drug

Prescription drug includes drugs dispensed by a pharmacy and is net of rebates.

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6. Trend Factors

Not applicable. This is a filing based on manual rate projections. Please see Section 8,"Manual Rate Adjustments", for details regarding the development of the Manual EHB AllowedClaims PMPM, which is on a 2020 calendar year basis.

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7. Adjustments to Trended EHB Allowed Claims PMPM

Not applicable. This is a filing based on manual rate projections. Please see Section 8,"Manual Rate Adjustments", for details regarding the development of the Manual EHB AllowedClaims PMPM, which is on a 2020 calendar year basis.

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8. Manual Rate Adjustments

Source and Appropriateness of Experience Data Used

Manual Experience Basis

The manual rate development is based on the Milliman Managed Care Rating Model (MCRM)and the companion Milliman Health Cost Guidelines (HCGs), and consideration of relevantQHP experience in other states. The MCRM includes several adjustments from the HCGs tobe consistent with and appropriate for the expected individual population that will be enrolled,including morbidity, geographic area utilization relativities, expected provider reimbursement,and utilization management programs.

The HCGs provide a flexible but consistent basis for the determination of claim costs for a widevariety of health benefit plans. These rating structures are used to anticipate future claimlevels, evaluate past experience, and establish interrelationships between different healthcoverage levels.

The Milliman HCGs are developed as a result of Milliman’s continuing research on health carecosts. They were first developed in 1954 and have been updated and expanded annually sincethen. These guidelines are continually monitored as we use them in measuring the experienceor evaluating the rates of our clients and as we compare them to other data sources.

The HCGs are a cooperative effort of all Milliman health actuaries and represent a combinationof their experience, research, and judgment. An extensive amount of data is used indeveloping these guidelines including published and unpublished data. In most instances, costassumptions are based on our evaluation of several data sources and, therefore, are notspecifically attributable to a single source. Since these guidelines are a proprietary documentof Milliman, they are only available for release to specific clients that lease these guidelinesand to Milliman consulting health actuaries.

Market-wide rates were developed based on the adjusted MCRM (see “Adjustments Made tothe Data” below for more detail on these adjustments). We used the HCGs to estimate thevalue of cost-sharing and relative utilization of services for each plan and to inform ratingfactors.

Manual Morbidity Basis

Composite morbidity factors are used to adjust the Milliman Managed Care Rating Model(MCRM) from the large employer group basis of the HCGs to the projected morbidity of PHW’smembership in 2020.

The morbidity for PHW's 2020 membership is assumed to equal the projected morbidity for thePennsylvania single risk pool times the morbidity of PHW's membership relative to the singlerisk pool.

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We estimated historical single risk pool morbidity by comparing historical risk adjustmentresults for the Pennsylvania individual market versus the employer group population underlyingthe HCGs, controlling for risk score differences attributable to non-morbidity factors (e.g.demographics and plan mix). We then projected this historical morbidity snapshot forward toaccount for expected changes in the risk pool composition over time

The relative morbidity assumption used for projecting claims reflects PHW’s expectationsregarding the morbidity of its 2020 membership relative to the single risk pool, and isconsistent with the relative morbidity assumption used to estimate PHW’s risk transferpayment/receivable.

Adjustments Made to the Data

The following adjustments were made to calibrate the pricing model to the expectedpopulation:

- Expected demographics- Expected morbidity- Cost trend and provider reimbursement- Expected utilization management savings- Utilization trend- Consideration of relevant QHP experience- Benefit plan designs and expected cost-sharing

See Appendix 8.1 for a demonstration of these adjustments. The adjustments, which arediscussed above, are appropriate and necessary to reflect the anticipated population, region,provider network, and benefits anticipated for the 2020 single risk pool.

Inclusion of Capitation Payments

Capitated payments for services are accounted for through a PMPM allocation to claims,where the average capitation amount replaces the projected claims amount.

15

9. Credibility of Experience

PHW does not have calendar year 2018 experience on which to base rate development. 0%credibility was assigned to experience.

16

10. Establishing the Index Rate

PHW did not offer products in 2018, so the Index Rate for the Experience Period does notapply.

The Index Rate for the Projection Period ($537.19) (calendar year 2020) is reflected inWorksheet 1, Section II of the URRT. It was developed following the specifications of 45 CFRpart 156.80(d)(1). The Index Rate for the Projection Period represents the estimated totalcombined projected allowed claims PMPM for EHBs for calendar year 2020 and has not beenadjusted for payments and charges under the risk adjustment program or for Exchange userfees. The total allowed claims include benefits in excess of EHBs (coverage for adult visionand adult dental). Pediatric dental is excluded in the benefit package since this will be offeredthrough a stand-alone plan on the Exchange. The Index Rate for the Projection Period wascalculated based on the methodology discussed in above and does not include benefits inexcess of the EHBs. The Index Rate for the Projection Period will remain unchanged until arenewal filing effective January 1, 2021.

The development of the Index Rate for the Projection Period is shown in Worksheet 1, SectionII. This reflects:

· The projection period of calendar year 2020

· The anticipated claim level of the projection period with respect to trend, benefits, anddemographics

· The experience of all policies expected to be in the single risk pool (with necessaryadjustments)

Appendix 10.1 demonstrates the calculation of the Projected Index Rate by blending theExperience Period Index Rate with the Credibility Manual Index Rate, as applicable. The nexttwo sections further describe the steps taken to develop the Market-wide Adjusted Index Rateand Plan Adjusted Index Rates.

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11. Development of Market-Wide Adjusted Index Rate

The Index Rate for the Projection Period is adjusted to arrive at the Market-wide AdjustedIndex Rate ($625.19) based on the following two adjustments, as outlined in 45 CFR156.80(d)(1):

· Adjustment for the Risk Adjustment Program

· Exchange user fee adjustment

Since the Index Rate is on an allowed claims basis, the market-level adjustments are appliedon an allowed basis. Similar to the Index Rate, the Market-wide Adjusted Index Rate reflectsthe average demographic characteristics of the single risk pool. The Market-wide AdjustedIndex Rate is not calibrated. Appendix 11.1 shows the development of the Market-wideAdjusted Index Rate.

Reinsurance

No state or federal reinsurance recoveries are expected in the projection period. As such, noreinsurance was entered in the field for projected reinsurance on URRT Worksheet 1, SectionII.


The Projected Risk Adjustment Transfer PMPM ''''''''''''''''''''' is shown on Worksheet 1, Section II.This amount does not include the 2020 Risk Adjustment User Fee of $0.18 PMPM (0.03% ofpremium). The Risk Adjustment User Fee is included with Taxes and Fees on Worksheet 2,Field #3.7. Appendix 11.1 shows how the anticipated risk adjustment transfer revenue isapplied to the Index Rate in the development of the Market-wide Adjusted Index Rate.

The state transfer calculation portion of the total risk adjustment transfer is based on the riskadjustment transfer formula, as provided in the Federal Register Volume 78 Number 47, anddisplayed below.

= × ×∑ ( × × × ) −

× × ×∑ ( × × × × )

Where:

s = state average premium;

PLRSi = plan i’s plan liability risk score;

AVi = plan i’s metal level AV;

ARFi = plan i‘s allowable rating factor;

IDFi = plan i’s induced demand factor;

GCFi = plan i’s geographic cost factor;

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si = plan i’s share of state enrollment as measured in member months;

and the denominator is summed across all plans in the risk pool in the market in the state.

We project the portfolio average for each factor in the risk adjustment transfer formula using acombination of (i) the state’s actual historical risk adjustment factors adjusted to the projectedpopulation and (ii) adjustments for market and risk adjustment program changes. The resultingaggregate payment or receivable is then proportionally allocated to all plans in the portfolio.

For the purpose of our modeling, each of these factors was approximated as follows.

P: The state average premium was assumed to be approximately ''''''''''' ''''''''''''''''' (net of the 14%administrative cost carve out).

PLRS: The statewide average risk score is projected based on the average PLRS of the singlerisk pool in 2017, as reported by the U.S. Department of Health and Human Services (HHS),adjusted for projected changes in the demographics, morbidity, and plan mix of the single riskpool from 2017 to 2020.

The average risk score for PHW’s membership is projected by adjusting the projected singlerisk pool average risk score for risk score differences associated with demographic, plan mix,and morbidity differences between the two populations.

HHS’s proposed HCC model and coefficient changes for 2019 and 2020 were considered inthe development of the projected risk adjustment transfer. The demographic, plan mix, andmorbidity assumptions supporting the projected statewide and PHW risk score projections areconsistent with the demographic, plan mix, and morbidity assumptions used to project claimscosts.

IDF: The statewide average IDF is projected based on the average IDF of the single risk poolin 2017, as reported by HHS.

The average IDF for PHW is projected by applying the induced demand factors from themarket reform rule published in the March 11, 2013 Federal Register, page 15433, Table 11 toPHW’s projected population. The formula recognizes the following IDF factors by metallic tier:Bronze 1.00, Silver 1.03, Gold 1.08 and Platinum 1.15.

AV: The statewide average actuarial value (AV) is projected based on the average metal levelAV of the single risk pool in 2017, as reported by HHS.

The average AV for PHW is projected by applying the metal level AV factors from the marketreform rule published in the March 11, 2013 Federal Register, page 15433, Table 9 to PHW’sprojected population. The formula recognizes the following AV values by metallic tier: Bronze0.60, Silver 0.70, Gold 0.80, and Platinum 0.90.

ARF: As stated in the March 11, 2013 Federal Register, page 15433, the allowable ratingfactor (ARF) adjustment accounts only for age rating.

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The statewide average ARF is projected based on the average ARF of the single risk pool in2017, as reported by HHS, adjusted for projected changes in the demographics of the singlerisk pool from 2017 to 2020.

The average ARF for PHW is projected by applying the proposed 2020 HHS age rating factorsto PHW’s projected population. An equal distribution across ages within each age band wasassumed.

GCF: The average GCF for PHW relative to the statewide average was modeled based onhistorical GCFs by rating area, any anticipated changes in these GCFs over time, and PHW’sprojected enrollment by rating area.

The total transfer is calculated as the sum of the state transfer calculation described above anda net transfer for 2020 attributable to the high cost risk pooling program. We modeled this asthe combination of a receivable, based on the attachment point and coinsurance from the 2020Notice of Benefit and Payment Parameters (NBPP), and an assessment, based as apercentage of premium.

Outliers were reflected in our calculations to the extent that outliers are reflected in historicalrisk scores used as the starting point of the 2020 risk transfer projection and via the calculationof the net high cost risk pooling receivable or payment. Otherwise, there were no “potentialoutlier assumptions” that would have an impact on transfers.

The projected transfer amount assumes no impact under the Risk Adjustment Data Validation(RADV) process.

The risk adjustment transfer amounts '''''''''''''''''''' shown on Worksheet 1 of the URRT are theactual PMPM amounts expected in the projection period. The risk adjustment transfer amountapplied to the Index Rate in the development of the Market Adjusted Index Rate is on anallowed claims basis, as the Index Rate is on an allowed claims basis.

The demographic, plan mix, and morbidity assumptions supporting the risk transfer projectionare consistent with the demographic, plan mix, and morbidity assumptions used to projectclaims costs.

Exchange User Fees

The Exchange user fee adjustment applied to premium rates is 3.00% of premium. This isbased on weighting the expected distribution of issuer enrollment sold through the Exchangeand sold outside of the Exchange. Per the 2020 final benefit and payment parameters, theExchange user fee is 3.00% of premium for members purchasing coverage via the Exchange,and there is no Exchange fee for members enrolling in coverage outside of the Exchange. Weassumed 100% of members would enroll through the Exchange and 0% would enroll outsideof the Exchange. On Appendix 11.1, the user fee is shown on an allowed basis as amultiplicative factor, and this factor is 1.036.

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12. Plan Adjusted Index Rate

The Plan Adjusted Index Rates (average Plan Adjusted Index Rate: $590.41) are included inWorksheet 2, Section III of the URRT. The Plan Adjusted Index Rates are the Market-wideAdjusted Index Rate adjusted for only the following allowable adjustments, where applicable,as outlined in 45 CFR 156.80(d)(2):

· The actuarial value and cost-sharing design of the plan

o The CMS Actuarial Value Calculator was used to determine the AV metal valuefor each plan.

o The actuarial value and cost-sharing pricing adjustment was developed using acombination of the Milliman Managed Care Rating Model (MCRM), calibrated tothe expected population, paired with a claims simulation methodology.

§ Relativities between plans were developed using a 50/50 blend of a claimssimulation method and the 2019 manual plan rating factors. The approachbalances the results of multiple methodologies and promotes marketstability.

§ Under a claims simulation approach to modeling plan relativities, member-level claims are re-adjudicated using the cost sharing parameters of eachplan design, thereby calculating plan versus patient liability.

§ The claims simulation model used here is based on a nationwide, claim-level dataset of Individual exchange members. Using this dataset for planrating factors ensures that a static demographic and risk profile informsthe rating factor of each plan, thereby excluding any differences in themorbidity of members assumed to select the plan.

§ The national dataset was calibrated to 2020 projected allowed costs toensure that member cost shares are applied to the appropriate cost level.Allowed relativities by plan reflect utilization differences originating frombenefit richness, based on the Milliman Health Cost Guidelines. Relyingon a manual model for these induced utilization differences precludes thereflection of morbidity.

§ Rate increases can vary by plan under this methodology without reflectingmorbidity differences. For example, rate increases naturally vary by planover time as the relationship changes between cost sharing levels and theallowed costs to which they are applied (i.e., leveraging).

o The actuarial and cost-sharing pricing adjustment reflects full plan liability forCSR subsidies. CSR costs are reflected as a uniform percentage load applied toeach silver ACA-compliant plan (both those sold through the Exchange andthose sold outside of the Exchange).

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· The plan’s provider network, delivery system characteristics, and utilizationmanagement adjustment practices.

o Not applicable. All plans have the same provider network.

· Benefits provided under the plan that are in addition to the EHBs.

o For a subset of plans, additional benefits include coverage for adult vision andadult dental.

· Administrative costs, excluding the Exchange user fees (which are already accountedfor in the Market-wide Adjusted Index Rate).

o Non-benefit expenses ($46.51) are discussed in detail below.

There are no catastrophic plans being offered, so there is no eligibility adjustment made forcatastrophic plan enrollment.

Administrative costs and other benefits (non-EHB) common to all plans are added to theMarket-wide Adjusted Index Rate. Then, factors for actuarial value and cost-sharing and non-EHBs by plan are applied to reach the Plan Adjusted Index Rate for each plan.

The development and values of the Plan Adjusted Index Rates are shown in Appendix 12.1.

The Plan Adjusted Index Rates reflect the average demographic characteristics of the singlerisk pool and are not calibrated.

The Plan Adjusted Index Rates of the Experience Period are set to zero as there is no reportedexperience on Worksheet 2, Section II of the URRT.

Administrative Expense Load

The administrative expense load ($41.51; 7.03% of Premium) was provided by PHW. Thisallowance is based on projected enrollment and is estimated to appropriately cover expensesfor overhead, operations, sales, and marketing expenses.

There is an additional amount to cover approved quality improvement expenses ($3.00) andprovider incentive payments ($2.00).

The administrative expenses are allocated proportionally by plan on a constant percentage ofpremium basis.

Profit (or Contribution to Surplus) & Risk Margin:

This load ($10.33; 1.75% of Premium) was applied proportionally to all products and plans andcan be found in Appendix 12.2.

A breakdown of administrative expenses can be found in Appendix 12.2.

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Taxes and Fees

The taxes and fees ($36.76) which may be subtracted from premiums for purposes ofcalculating the MLR are listed in Appendix 12.2.

For 2020, the Risk Adjustment User Fee is included as part of Taxes and Fees on Worksheet2, Field #3.7 of the URRT.

See Section 11, “Development of Market-wide Adjusted Index Rate”, for discussion on how theExchange user fee is calculated and applied to the Market-wide Adjusted Index Rate.

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13. Calibration

The Plan Adjusted Index Rates are calibrated for plans within the single risk pool tocorrespond to an age rating factor of 1.0, a geographic rating factor of 1.0, and a tobacco userating factor of 1.0. The intent of the calibration factors is to reset the Plan Adjusted IndexRates so that applying the age factor, geographic rating area factor, and tobacco use factor willresult in the appropriate consumer adjusted premium rate. The calibration factors for each ofthe age, geographic, and tobacco use factors are shown in Appendix 13.1. Note that each ofthe calibration factors has one value that is applied uniformly and does not vary by plan.

Age Curve Calibration

The age curve calibration factor (1.729) is applied in Appendix 13.1. The age curve calibrationfactor is calculated by weighting the prescribed age rating factors with the projected single riskpool membership distribution. This age curve calibration calculation is based on page 9 of theDraft 2020 Unified Rate Review Instructions. The age factor for each age band is the simpleaverage of the factors in that band. The rounded weighted average age corresponding to thisage calibration factor is 49 years.

Appendix 13.1 of the Actuarial Memorandum demonstrates the calibration of the Plan AdjustedIndex Rates for age. The distribution of members by age is in Appendix 1.2 and the age factorsare in Appendix 1.3.

Geographic Factor Calibration

The geographic rating factors are displayed in Appendix 1.3.

Tobacco Use Rating Factor Calibration

The tobacco use calibration factor (1.006) is applied in Appendix 13.1. The tobacco usecalibration factor removes the portion of the cost expected to be recouped through the tobaccosurcharge. This factor is calculated by weighting the tobacco factors with the single risk poolmembership distribution of tobacco and non-tobacco users. The tobacco factors are listed inAppendix 1.3.

Calibration adjustments are applied uniformly to all plans

The calibration adjustment (1.739) does not vary by plan as is evident in Appendix 13.1. Themember-level adjustments as described in 45 CFR 147.102 are applied uniformly to all plansin the single risk pool, and these adjustments do not vary by plan.

On Appendix 13.1, the Plan Adjusted Index Rates are calibrated for age, tobacco, andgeography to determine the Calibrated Plan Adjusted Index Rates ($339.60). Multiplying theCalibrated Plan Adjusted Index Rate by the age, tobacco, and area factors produces theConsumer Adjusted Premium Rate. The distribution of members by rating area is in Appendix1.2. Appendix 1.4 lists the steps to calculate final premium rates and shows the calculation foran example policy with family coverage.

24

14. Consumer Adjusted Premium Rate Development

Each Plan Adjusted Index Rate is divided by the overall calibration factor to determine thecorresponding Calibrated Plan Adjusted Index Rate.

The following allowable rating factors, as specified by 45 CFR Part 147.102, are applied to theCalibrated Plan Adjusted Index Rate to determine the rate that is charged to the healthinsurance purchaser:

· Age

o The prescribed standard age factors were used.

· Rating Area

o The area factors are listed in Appendix 1.3. The methodology for developinggeographic factors is included in Section 13, “Calibration”.

· Tobacco status

o The tobacco factor for 2020 is set to 1.15 for all ages 18+. In lieu of credible data,the factor was selected from a reasonable range of cost impacts based ontobacco cost literature. Specifically, the report “The Business Case for Coverageof Tobacco Cessation, 2012 Update” by Leif Associates, Inc. was consideredwhich suggests that healthcare costs for smokers are greater than those of non-smokers and may be as much as 34% higher than costs for non-smokers.

· For family coverage, rates for children are charged to no more than the three oldestcovered children under age 21.

Appendix 1.3 lists the allowable rating factors and Appendix 1.4 has an example calculation ofa family’s rates.

25

15. Projected Loss Ratio

The projected medical loss ratio (MLR) is 90.6%. The projected MLR is based on theprescribed calculation from 45 CFR 158, but solely reflects the projection year single risk poolexperience, rather than the three-year combined period that is used for determining MLRrebates. There was no credibility adjustment applied to the projected MLR. Including acredibility adjustment would only increase the projected MLR, which already satisfies the MLRrequirement. See Appendix 15.1 for the calculation for the projected federal medical loss ratio.

26

16. AV Metal Values

The AV Metal Values included in Worksheet 2 of the Part I URRT were calculated using theFinal 2020 Federal AV Calculator released on March 19, 2019. Please refer to Appendix 16.1for screenshots documenting the outcomes of the AV Calculator for each plan.

27

17. Membership Projections

PHW developed its membership projections shown on Worksheet 2 of the URRT by startingwith its own relevant 2019 QHP open enrollment data and adjusting for expected enrollmentchanges through 2020.

For Silver plan membership, the membership projections break out enrollment separately foreach cost-sharing reduction subsidy level. The detail of the projected membership by subsidylevel is shown in Appendix 17.1.

28

18. Terminated Plans and Products

A list of the plans being terminated and the plans to which these are being mapped is includedin the appendices as Appendix 18.1.

29

19. Plan Type

The Plan types listed in Worksheet 2, Section I of the Part I URRT describe PHW’s plansexactly.

30

20. Effective Rate Review Information

The following Pennsylvania state-specific requirements have been included elsewhere in thisfiling package:

· 2020_PHW_State_Actuarial_Memo_20190513.pdf

· 2020_PHW_Actuarial_Memorandum_Rate_Exhibits_20190624.xlsm

· 2020_PHW_Plan_Design_Summary_and_Rate_Tables_20190624.xlsb

· 2020_PHW_Completeness_and_Redaction_Checklist_20190513.xlsm

· 2020_PHW_Pennsylvania_Counties_Map_20190513.ppt

· 2020_PHW_State_Required_Cover_Letter_20190624.docx

· 2020_PHW_Rate_Change_Request_Summary_20190513.pdf

· 2020_PHW_Redaction_Justification_20190513.pdf

· 2020_PHW_Public_Rate_Filing_PDF_20190513.pdf

31

21. Reliance

In the preparation of this filing, I relied upon data provided under the direction of ''''''''''''''''''''''''''''''''', Pennsylvania Health & Wellness, Inc.. I performed general reasonableness checks,but I have not audited the data and have relied upon its accuracy. To the extent that theunderlying data is inaccurate, this filing may also be inaccurate. Actual results will vary fromthose projected in the filing. This is due to random fluctuations, unexpected large claims,changes in population, and other such factors.

See Appendix 21.1 for a listing of items received for the rate development.

32

22. Actuarial Certification

I, '''''''''''' '''''''''''''''', am a member of the American Academy of Actuaries in good standing andmeet its qualification standards for actuaries issuing statements of actuarial opinion in theUnited States promulgated by the American Academy of Actuaries, and have the educationand experience necessary to perform the work. This filing is prepared on behalf ofPennsylvania Health & Wellness, Inc. (the “Company”) to comply with applicable State andFederal Statutes for individual rate filings.

I am affiliated with Milliman, Inc. (“Milliman”), an independent actuarial consulting firm that isnot affiliated with, nor a subsidiary of, nor in any way owned or controlled by a health plan,health insurer, or a trade association of health plans or insurers.

I certify the rates were developed in accordance with the appropriate Actuarial Standards ofPractice (ASOPs) and the profession’s Code of Professional Conduct. While other ASOPsapply, particular emphasis was placed on the following:

· ASOP No. 5, Incurred Health and Disability Claims· ASOP No. 8, Regulatory Filings for Health Benefits, Accident and Health Insurance, and

Entities Providing Health Benefits· ASOP No. 12, Risk Classification· ASOP No. 23, Data Quality· ASOP No. 25, Credibility Procedures· ASOP No. 26, Compliance with Statutory and Regulatory Requirements for the

Actuarial Certification of Small Employer Health Benefit Plans· ASOP No. 41, Actuarial Communications· ASOP No. 42, Health and Disability Actuarial Assets and Liabilities Other Than

Liabilities for Incurred Claims· ASOP No. 45, The Use of Health Status Based Risk Adjustment Methodologies· ASOP No. 50, Determining Minimum Value and Actuarial Value under the Affordable

Care Act

I certify that to the best of my knowledge and judgment:

1. The Index Rate for the Projection Period is:

a. In compliance with all applicable State and Federal Statutes and Regulations(45 CFR 156.80 and 147.102)

b. Developed in compliance with the applicable Actuarial Standards of Practice

c. Reasonable in relation to the benefits provided and the population anticipatedto be covered

d. Neither excessive nor deficient based on my best estimates of the 2020individual market.

2. The Index Rate and only the allowable modifiers as described in 45 CFR156.80(d)(1) and 45 CFR 156.80(d)(2) were used to generate plan-level rates.

33

3. The geographic rating factors used reflect only differences in the cost of delivery(which can include unit cost and provider practice pattern differences) and do notinclude differences for population morbidity by geographic area.

4. The CMS Actuarial Value Calculator was used to determine the AV Metal Valuesshown in Worksheet 2, Section I of the URRT for all plans.

5. All factor, benefit, and other changes from the 2019 filing have been disclosed.

6. No new plan is a modification of an existing plan.

7. The information presented in the PA Actuarial Memorandum and PA ActuarialMemorandum Rate Exhibits is consistent with the information presented in the2020 Rate Filing Justification.

The URRT does not demonstrate the process used to develop proposed premium rates. It isrepresentative of information required by Federal regulation to be provided in support of thereview of rate increases, for certification of qualified health plans and for certification that theIndex Rate is developed in accordance with Federal regulation and used consistently and onlyadjusted by the allowable modifiers.

The 2020 plan year premium rates in this actuarial memorandum are contingent upon thestatus of the ACA statutes and regulations including any regulatory guidance, court decisions,or otherwise. Changes have the potential to greatly impact the 2020 plan year premium ratesprovided in this Actuarial Memorandum and the alignment of these premium rates withincurred costs. Changes include, but are not limited to, any legislative or regulatoryamendment, court decision, 1332 waivers bringing reinsurance or other such programs to astate; or a decision by Congress, the Health and Human Services Secretary, or the Centers forMedicare and Medicaid Services director to fund cost-sharing reduction subsidies, alteradvance premium tax credits, or further modify the individual mandate requirement andpenalty. In the event that a material provision is impacted, a revision to the rates will beneeded. In particular, rates were developed assuming steady funding of Advanced PremiumTax Credits (APTCs) and no funding of cost-sharing reduction (CSR) subsidy payments. Thecontinuity of this funding approach will impact whether rates are sufficient and not excessive.Milliman expresses no opinion with regard to the future funding of CSR payments.

34

The information provided in this actuarial memorandum is in support of the items illustrated inthe URRT and does not provide an actuarial opinion regarding the URRT’s process used todevelop proposed premium rates. It does certify that rates were developed in accordance withapplicable regulations, as noted.

It is certain that actual experience will not conform exactly to the assumptions used in thisanalysis.

Signed:

Name: '''''''''''' '''''''''''''''

Title: Consulting Actuary

Date: June 24, 2019

Appendix 1.1Pennsylvania Health & Wellness, Inc.

Description of Benefits

Rx Member Cost-Sharing

Plan Design Plan ID Plan TypeMedical

DeductibleMember

CoinsuranceRx

DeductibleOOP Max PCP Visit

SpecialistVisit

GenericPreferred

BrandNon-Preferred

BrandSpecialty

Includes adultvision

coverage?

Includes adultdental

coverage?

Ambetter Secure Care 5 (2020) 86199PA0010025 HMO $1250 INT 20% INT $5,900 $15 NSD $35 NSD $15 NSD $30 NSD 30% SD 30% SD N NAmbetter Balanced Care 5 (2020) 86199PA0010005 HMO $7350 INT 0% INT $7,350 $40 NSD $80 NSD $20 NSD $60 NSD $0 SD $0 SD N NAmbetter Balanced Care 11 (2020) 86199PA0010004 HMO $6000 INT 40% INT $8,100 $30 NSD $60 NSD $20 NSD $50 NSD 50% SD 50% SD N NAmbetter Balanced Care 12 (2020) 86199PA0010012 HMO $6500 INT 40% INT $8,150 $35 NSD $70 NSD $25 NSD $60 NSD 50% SD 50% SD N NAmbetter Balanced Care 14 (2020) 86199PA0010014 HMO $0 INT 50% INT $8,150 $45 NSD $95 NSD $36 NSD 50% NSD D&C D&C N NAmbetter Balanced Care 15 (2020) 86199PA0010015 HMO $2950 INT 40% INT $8,150 $30 NSD $65 NSD $15 NSD $60 NSD 50% SD 50% SD N NAmbetter Essential Care 1 (2020) 86199PA0010002 HMO $8150 INT 0% INT $8,150 $0 SD $0 SD $20 NSD $0 SD $0 SD $0 SD N NAmbetter Essential Care 2 HSA (2020) 86199PA0010022 HMO $6750 INT 0% INT $6,750 $0 SD $0 SD $0 SD $0 SD $0 SD $0 SD N NAmbetter Essential Care 4 HSA (2020) 86199PA0010024 HMO $5400 INT 30% INT $6,750 D&C D&C D&C D&C 40% SD 40% SD N NAmbetter Essential Care 10 (2020) 86199PA0010006 HMO $7200 INT 50% INT $8,150 50% NSD D&C $20 NSD D&C D&C D&C N N

Ambetter Secure Care 5 (2020) + Vision + Adult Dental 86199PA0020025 HMO $1250 INT 20% INT $5,900 $15 NSD $35 NSD $15 NSD $30 NSD 30% SD 30% SD Y YAmbetter Balanced Care 5 (2020) + Vision + Adult Dental 86199PA0020005 HMO $7350 INT 0% INT $7,350 $40 NSD $80 NSD $20 NSD $60 NSD $0 SD $0 SD Y YAmbetter Balanced Care 11 (2020) + Vision + Adult Dental 86199PA0020004 HMO $6000 INT 40% INT $8,100 $30 NSD $60 NSD $20 NSD $50 NSD 50% SD 50% SD Y YAmbetter Balanced Care 12 (2020) + Vision + Adult Dental 86199PA0020012 HMO $6500 INT 40% INT $8,150 $35 NSD $70 NSD $25 NSD $60 NSD 50% SD 50% SD Y YAmbetter Balanced Care 14 (2020) + Vision + Adult Dental 86199PA0020014 HMO $0 INT 50% INT $8,150 $45 NSD $95 NSD $36 NSD 50% NSD D&C D&C Y YAmbetter Balanced Care 15 (2020) + Vision + Adult Dental 86199PA0020015 HMO $2950 INT 40% INT $8,150 $30 NSD $65 NSD $15 NSD $60 NSD 50% SD 50% SD Y YAmbetter Essential Care 1 (2020) + Vision + Adult Dental 86199PA0020002 HMO $8150 INT 0% INT $8,150 $0 SD $0 SD $20 NSD $0 SD $0 SD $0 SD Y YAmbetter Essential Care 10 (2020) + Vision + Adult Dental 86199PA0020006 HMO $7200 INT 50% INT $8,150 50% NSD D&C $20 NSD D&C D&C D&C Y Y

D&C – Deductible and CoinsuranceINT – Integrated Medical and Rx DeductibleNSD – Not subject to deductibleSD – Subject to deductibleRx Copay – Generic / Preferred Brand / Non-Preferred Brand / Specialty

Milliman


Age and Rating Area Distributions

Age Percent Rating PercentBand Distribution Area Distribution0-14 1.14% Rating Area 8 100.0%15 0.08%16 0.08%17 0.08%18 0.08%19 1.08%20 1.08%21 1.08%22 1.08%23 1.08%24 1.08%25 2.44%26 2.44%27 2.44%28 2.44%29 2.44%30 2.33%31 2.33%32 2.33%33 2.33%34 2.33%35 1.84%36 1.84%37 1.84%38 1.84%39 1.84%40 1.89%41 1.89%42 1.89%43 1.89%44 1.89%45 1.79%46 1.79%47 1.79%48 1.79%49 1.79%50 2.32%51 2.32%52 2.32%53 2.32%54 2.32%55 2.51%56 2.51%57 2.51%58 2.51%59 2.51%60 2.94%61 2.94%62 2.94%63 2.94%

64 and Over 4.71%

Milliman


Rating Factors

Age Age Tobacco Factors Geographic FactorsBand Factor Smoker Non-Smoker Rate

0-14 0.765 1.000 1.000 Area Factor15 0.833 1.000 1.000 Rating Area 8 1.000016 0.859 1.000 1.00017 0.885 1.000 1.00018 0.913 1.150 1.00019 0.941 1.150 1.00020 0.970 1.150 1.00021 1.000 1.150 1.00022 1.000 1.150 1.00023 1.000 1.150 1.00024 1.000 1.150 1.00025 1.004 1.150 1.00026 1.024 1.150 1.00027 1.048 1.150 1.00028 1.087 1.150 1.00029 1.119 1.150 1.00030 1.135 1.150 1.00031 1.159 1.150 1.00032 1.183 1.150 1.00033 1.198 1.150 1.00034 1.214 1.150 1.00035 1.222 1.150 1.00036 1.230 1.150 1.00037 1.238 1.150 1.00038 1.246 1.150 1.000

39 1.262 1.150 1.00040 1.278 1.150 1.00041 1.302 1.150 1.00042 1.325 1.150 1.00043 1.357 1.150 1.00044 1.397 1.150 1.00045 1.444 1.150 1.00046 1.500 1.150 1.00047 1.563 1.150 1.00048 1.635 1.150 1.00049 1.706 1.150 1.00050 1.786 1.150 1.00051 1.865 1.150 1.00052 1.952 1.150 1.00053 2.040 1.150 1.00054 2.135 1.150 1.00055 2.230 1.150 1.00056 2.333 1.150 1.00057 2.437 1.150 1.00058 2.548 1.150 1.00059 2.603 1.150 1.00060 2.714 1.150 1.00061 2.810 1.150 1.00062 2.873 1.150 1.00063 2.952 1.150 1.000

64 and Over 3.000 1.150 1.000

Milliman


Rating Example

Family Rating Example

Plan Design: Ambetter Secure Care 5 (2020)Product: 86199PA001

(a) (b) (c) (d)(e) = (a) x (b) x

(c) x (d)

Member Age Smoking Status Rating AreaCalibrated Plan Adjusted

Index Rate Age Factor Tobacco Area Final PremiumSubscriber 40 Non-Smoker Rating Area 8 $403.83 1.278 1.000 1.0000 $516.09Spouse 38 Non-Smoker Rating Area 8 $403.83 1.246 1.000 1.0000 $503.17Child 1 18 Non-Smoker Rating Area 8 $403.83 0.913 1.000 1.0000 $368.70Child 2 16 Non-Smoker Rating Area 8 $403.83 0.859 1.000 1.0000 $346.89Child 3 14 Non-Smoker Rating Area 8 $403.83 0.765 1.000 1.0000 $308.93Child 4 11 Non-Smoker Rating Area 8 $403.83 0.000 1.000 1.0000 $0.00Total $2,043.78

Steps to Calculate Final Premium:(1) Look up the plan's Calibrated Plan Adjusted Index Rate (a).(2) Look up the age factors for each member based on age (b). Note that premiums can only be charged for the first 3 children, so the age factor for all subsequent children will be 0.(3) Look up the tobacco factor for each member according to smoking status and age (c).(4) Look up the area factor based on the rating area (d).(5) Multiply column (a) by the age, tobacco and area factors for each member individually.(6) Sum the results from (5) for the final premium for the family.

Milliman

Appendix 2.1Celtic Insurance Company

Significant Factors Driving Proposed Rate Increases by Plan

(12) = (13) =(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (2) *...* (11) - 1 (1) * [1 + (12)]

Feb. 2019 2019 Risk Adj. & Util Trend & Prov. Reimb. & Benefit Design & Taxes & Demog. & Admin & Current Total Rate 20202020 Plan Name 2020 Plan ID Members Premium SWAP Single Risk Pool Unit Cost Trend CSR Subsidies Fees Morbidity Age Factors Profit Other Enrollment Change PremiumAmbetter Secure Care 5 (2020) 86199PA0010025 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 5 (2020) 86199PA0010005 192 $637.10 0.994 1.014 1.004 1.034 1.001 0.986 0.988 0.984 0.997 1.000 0.1% $637.69Ambetter Balanced Care 11 (2020) 86199PA0010004 990 $604.31 0.994 1.014 1.004 1.037 1.001 0.986 0.988 0.984 0.997 1.000 0.4% $606.65Ambetter Balanced Care 12 (2020) 86199PA0010012 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 14 (2020) 86199PA0010014 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 15 (2020) 86199PA0010015 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Essential Care 1 (2020) 86199PA0010002 646 $577.83 0.994 1.014 1.004 0.980 1.001 0.986 0.988 0.984 0.997 1.001 -5.0% $548.75Ambetter Essential Care 2 HSA (2020) 86199PA0010022 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Essential Care 4 HSA (2020) 86199PA0010024 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Essential Care 10 (2020) 86199PA0010006 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Secure Care 5 (2020) + Vision + Adult Dental 86199PA0020025 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 5 (2020) + Vision + Adult Dental 86199PA0020005 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 11 (2020) + Vision + Adult Dental 86199PA0020004 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 12 (2020) + Vision + Adult Dental 86199PA0020012 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 14 (2020) + Vision + Adult Dental 86199PA0020014 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Balanced Care 15 (2020) + Vision + Adult Dental 86199PA0020015 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Essential Care 1 (2020) + Vision + Adult Dental 86199PA0020002 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/AAmbetter Essential Care 10 (2020) + Vision + Adult Dental 86199PA0020006 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/ATotal 1,828 $598.40 -1.5% $589.45

Milliman


Benefit Category Mapping

URRT BenefitMCRM Benefit Category Category

Inpatient Facility - Non-Maternity Medical Inpatient Hospital Medical - Other Newborn Inpatient Hospital Surgical Inpatient Hospital Psychiatric - Hospital Inpatient Hospital Psychiatric - Residential Inpatient Hospital Alcohol & Drug Abuse - Hospital Inpatient Hospital Alcohol & Drug Abuse - Residential Inpatient Hospital

Inpatient Facility - Maternity Normal Deliveries Inpatient Hospital Cesarean Deliveries Inpatient Hospital Non-Deliveries Inpatient Hospital

Skilled Nursing Facility Inpatient Hospital

Outpatient Facility Observation Outpatient Hospital Emergency Room Outpatient Hospital Surgery Outpatient Hospital Radiology Radiology - Therapeutic Outpatient Hospital Radiology - Diagnostic Outpatient Hospital Radiology - CT / MRI / PET Outpatient Hospital Pathology/Lab Outpatient Hospital Pharmacy Outpatient Hospital Cardiovascular Outpatient Hospital PT/OT/ST Outpatient Hospital Psychiatric Outpatient Hospital Alcohol & Drug Abuse Outpatient Hospital Preventive Outpatient Hospital Other Outpatient Facility Outpatient Hospital

Professional Inpatient Surgery - Non-Maternity Surgeon Professional Anesthesia Professional

Maternity Professional Professional Anesthesia Professional

Outpatient Surgery Outpatient Facility Professional Office Professional Anesthesia Professional

Inpatient Visits Medical Professional Psychiatric Professional Alcohol & Drug Abuse Professional

Office Visits & Miscellaneous Services Office/Home Visits - PCP Professional Office/Home Visits - Specialist Professional Urgent Care Visits Professional Office Administered Drugs Professional Allergy Testing Professional Allergy Immunotherapy Professional

Milliman


Benefit Category Mapping

URRT BenefitMCRM Benefit Category Category

Miscellaneous Medical Professional

Preventive Services Immunizations Professional Well Baby Exams Professional Physical Exams Professional Other Preventive Professional

Other Professional Services ER Visits and Observation Care Professional Vision Exams Professional Hearing and Speech Exams Professional Physical Therapy Professional Cardiovascular Professional Radiology Inpatient Professional Outpatient Outpatient - Therapeutic Professional Outpatient - Diagnostic Professional Outpatient - CT / MRI / PET Professional Office Office - Therapeutic Professional Office - Diagnostic Professional Office - CT / MRI / PET Professional Pathology/Lab Inpatient & Outpatient Professional Office Professional Chiropractor Professional Outpatient Psychiatric Professional Outpatient Alcohol & Drug Abuse Professional

Other Prescription Drugs Prescription Drug Private Duty Nursing/Home Health Other Medical Ambulance Other Medical DME and Supplies Other Medical Prosthetics Other Medical Autism - ABA Other Medical IUD Contraceptive Other Medical Implantable Rod Contraceptive Other Medical Infertility Other Medical Envolve Vision - Child - Exam / Hardware Capitation Envolve Vision - Child - Med / Surg Capitation Envolve Vision - Adult - Med / Surg Capitation Envolve PeopleCare - Health Coaching Capitation Envolve PeopleCare - Nurseline Capitation Start Smart Capitation Teledoc - Telehealth Capitation

Adult Vision / Adult Dental Envolve Vision - Adult - Exam / Hardware Capitation Envolve Dental - Adult Capitation

Milliman

Appendix 8.1


Manual Rate Buildup

Claims PMPM

Line Item Total Impact

Base Data $365.14

* Cost trend and provider reimbursement 388.14 1.063

* Rating region - Cost 429.33 1.106

* Rating region - Util 483.02 1.125

* Utilization trend 505.43 1.046

* Calibration based on relevant QHP experience 468.88 0.928

* Prior Auth. / DUR / Disease Management 461.87 0.985

* Induced Utilization 437.70 0.948

* Expected morbidity 483.14 1.104

* Expected demographics 583.37 1.207

* Expected utilization management savings 543.17 0.931

* Benefit plan designs 535.04 0.985

* Grace Period 537.19 1.004

Manual EHB Allowed Claims PMPM $537.19

Milliman

Appendix 10.1Pennsylvania Health & Wellness, Inc.Index Rate to Projected Index Rate

(1) (2) (3) (4) (5) = (2) * (4) + (3) * [1 - (4)]

Projected Experience CredibilityMember Period Manual Credibility Projected

Plan ID Plan Name Months Index Rate (Projected) Index Rate (Projected) Factor Index Rate86199PA0010025 Ambetter Secure Care 5 (2020) 1,344 N/A $537.19 0% $537.1986199PA0010005 Ambetter Balanced Care 5 (2020) 8,856 N/A 537.19 0% 537.1986199PA0010004 Ambetter Balanced Care 11 (2020) 31,591 N/A 537.19 0% 537.1986199PA0010012 Ambetter Balanced Care 12 (2020) 21,953 N/A 537.19 0% 537.1986199PA0010014 Ambetter Balanced Care 14 (2020) 3,446 N/A 537.19 0% 537.1986199PA0010015 Ambetter Balanced Care 15 (2020) 44 N/A 537.19 0% 537.1986199PA0010002 Ambetter Essential Care 1 (2020) 15,835 N/A 537.19 0% 537.1986199PA0010022 Ambetter Essential Care 2 HSA (2020) 12 N/A 537.19 0% 537.1986199PA0010024 Ambetter Essential Care 4 HSA (2020) 5,972 N/A 537.19 0% 537.1986199PA0010006 Ambetter Essential Care 10 (2020) 15,828 N/A 537.19 0% 537.1986199PA0020025 Ambetter Secure Care 5 (2020) + Vision + Adult Dental 94 N/A 537.19 0% 537.1986199PA0020005 Ambetter Balanced Care 5 (2020) + Vision + Adult Dental 653 N/A 537.19 0% 537.1986199PA0020004 Ambetter Balanced Care 11 (2020) + Vision + Adult Dental 2,328 N/A 537.19 0% 537.1986199PA0020012 Ambetter Balanced Care 12 (2020) + Vision + Adult Dental 1,624 N/A 537.19 0% 537.1986199PA0020014 Ambetter Balanced Care 14 (2020) + Vision + Adult Dental 253 N/A 537.19 0% 537.1986199PA0020015 Ambetter Balanced Care 15 (2020) + Vision + Adult Dental 4 N/A 537.19 0% 537.1986199PA0020002 Ambetter Essential Care 1 (2020) + Vision + Adult Dental 1,096 N/A 537.19 0% 537.1986199PA0020006 Ambetter Essential Care 10 (2020) + Vision + Adult Dental 1,096 N/A 537.19 0% 537.19Total 112,029 N/A $537.19 0% $537.19

Milliman


Projected Index Rate to Market Adjusted Index Rate

(5) (6) (7) (8) = (5) * (6) * (7)

Projected Net Risk Adjustment Exchange Market AdjustedPlan ID Plan Name Index Rate Transfer Factor User Fee Factor Index Rate86199PA0010025 Ambetter Secure Care 5 (2020) $537.19 1.124 1.036 $625.1986199PA0010005 Ambetter Balanced Care 5 (2020) 537.19 1.124 1.036 625.1986199PA0010004 Ambetter Balanced Care 11 (2020) 537.19 1.124 1.036 625.1986199PA0010012 Ambetter Balanced Care 12 (2020) 537.19 1.124 1.036 625.1986199PA0010014 Ambetter Balanced Care 14 (2020) 537.19 1.124 1.036 625.1986199PA0010015 Ambetter Balanced Care 15 (2020) 537.19 1.124 1.036 625.1986199PA0010002 Ambetter Essential Care 1 (2020) 537.19 1.124 1.036 625.1986199PA0010022 Ambetter Essential Care 2 HSA (2020) 537.19 1.124 1.036 625.1986199PA0010024 Ambetter Essential Care 4 HSA (2020) 537.19 1.124 1.036 625.1986199PA0010006 Ambetter Essential Care 10 (2020) 537.19 1.124 1.036 625.1986199PA0020025 Ambetter Secure Care 5 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.1986199PA0020005 Ambetter Balanced Care 5 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.1986199PA0020004 Ambetter Balanced Care 11 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.1986199PA0020012 Ambetter Balanced Care 12 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.1986199PA0020014 Ambetter Balanced Care 14 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.1986199PA0020015 Ambetter Balanced Care 15 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.1986199PA0020002 Ambetter Essential Care 1 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.1986199PA0020006 Ambetter Essential Care 10 (2020) + Vision + Adult Dental 537.19 1.124 1.036 625.19Total $537.19 1.124 1.036 $625.19

Milliman


Projected Risk Adjustment Transfers for 2020

Appendix 11.2 has been redacted.

Milliman

Appendix 11.3Pennsylvania Health & Wellness, Inc.Development of Appendix 11.1 Values

(b+a/c) / b Net Risk Adjustment Transfer Factor 1.124(a) Risk Adjustment Transfer (App 15.1) $54.57(b) Projected Index Rate (App 10.1) $537.19(c) Paid to Allowed Ratio (App 20.3) 0.821

(c+(a+b)/d) / (c+b/d) Exchange User Fee Factor 1.036(a) Pennsylvania Exchange Fee (App 12.2) $17.71(b) Risk Adjustment Transfer (App 15.1) $54.57(c) Projected Index Rate (App 10.1) $537.19(d) Paid to Allowed Ratio (App 20.3) 0.821

Milliman


Market Adjusted Index Rate to Plan Adjusted Index Rate

(8) (9) (10) (11) (12) (13) (14) = (15) = (8) * (14)Provider Network, Administrative Impact of Specific (9) * ... * (13)

Actuarial Value Delivery System Benefits in Costs Excluding EligibilityMarket Adjusted and Cost-Sharing and Utilization Addition to Exchange Categories for Plan Adjusted

Plan ID Plan Name Index Rate Design of the Plan Management the EHBs User Fees Catastrophic Plans AV Pricing Value Index Rate86199PA0010025 Ambetter Secure Care 5 (2020) $625.19 0.979 1.000 1.000 1.147 1.000 1.123 $702.0886199PA0010005 Ambetter Balanced Care 5 (2020) 625.19 0.896 1.000 1.000 1.147 1.000 1.028 642.8186199PA0010004 Ambetter Balanced Care 11 (2020) 625.19 0.885 1.000 1.000 1.147 1.000 1.016 635.0386199PA0010012 Ambetter Balanced Care 12 (2020) 625.19 0.874 1.000 1.000 1.147 1.000 1.002 626.6186199PA0010014 Ambetter Balanced Care 14 (2020) 625.19 0.959 1.000 1.000 1.147 1.000 1.100 687.7486199PA0010015 Ambetter Balanced Care 15 (2020) 625.19 0.957 1.000 1.000 1.147 1.000 1.098 686.2686199PA0010002 Ambetter Essential Care 1 (2020) 625.19 0.674 1.000 1.000 1.147 1.000 0.774 483.6586199PA0010022 Ambetter Essential Care 2 HSA (2020) 625.19 0.721 1.000 1.000 1.147 1.000 0.827 517.2186199PA0010024 Ambetter Essential Care 4 HSA (2020) 625.19 0.735 1.000 1.000 1.147 1.000 0.843 526.9886199PA0010006 Ambetter Essential Care 10 (2020) 625.19 0.708 1.000 1.000 1.147 1.000 0.812 507.5086199PA0020025 Ambetter Secure Care 5 (2020) + Vision + Adult Dental 625.19 0.979 1.000 1.047 1.147 1.000 1.176 735.0586199PA0020005 Ambetter Balanced Care 5 (2020) + Vision + Adult Dental 625.19 0.896 1.000 1.047 1.147 1.000 1.076 673.0086199PA0020004 Ambetter Balanced Care 11 (2020) + Vision + Adult Dental 625.19 0.885 1.000 1.047 1.147 1.000 1.063 664.8686199PA0020012 Ambetter Balanced Care 12 (2020) + Vision + Adult Dental 625.19 0.874 1.000 1.047 1.147 1.000 1.049 656.0486199PA0020014 Ambetter Balanced Care 14 (2020) + Vision + Adult Dental 625.19 0.959 1.000 1.047 1.147 1.000 1.152 720.0486199PA0020015 Ambetter Balanced Care 15 (2020) + Vision + Adult Dental 625.19 0.957 1.000 1.047 1.147 1.000 1.149 718.4986199PA0020002 Ambetter Essential Care 1 (2020) + Vision + Adult Dental 625.19 0.674 1.000 1.047 1.147 1.000 0.810 506.3686199PA0020006 Ambetter Essential Care 10 (2020) + Vision + Adult Dental 625.19 0.708 1.000 1.047 1.147 1.000 0.850 531.33Total $625.19 0.821 1.000 1.003 1.147 1.000 0.944 $590.41

Milliman

Appendix 12.2Pennsylvania Health & Wellness, Inc.Summary of Non-Benefit Expenses

Expense Component PMPM% of NetRevenue

% of AggregatePremium

Aggregate Premium $590.41 100.00%Net Revenue $535.84 100.00%

Administrative Expense LoadGeneral Administrative Expense

Core CNC Admin $34.35 5.82%Sales Compensation $3.26 0.55%Marketing - Lead Generation $2.30 0.39%Commercial Stop Loss $0.72 0.12%Marketing - Post Enrollment Marketing Costs $0.00 0.00%Risk Adjustment Optimization $0.00 0.00%Premium Billings $0.00 0.00%Connecture Front-End $0.00 0.00%Non-Benefit Portion of Capitation Arrangements $0.89 0.15%

Quality Improvement Expense $3.00 0.51%Provider Incentive Payments $2.00 0.34%Total $46.51 7.88%

Post-Tax Profit and Contribution to Surplus $10.33 1.75%

Taxes and Fees - % of PremiumState Income Tax $1.60 0.27%Federal Income Tax $3.17 0.54%Federal Transitional Reinsurance Program Fee $0.00 0.00%Patient Centered Outcomes Research Fee $0.00 0.00%Pennsylvania Exchange Fee $17.71 3.00%Total $22.48 3.81%

Taxes and Fees - % of Net RevenueHealth Insurance Provider Fee $14.09 2.63%Assessments $0.00 0.00%Misc. Taxes and Fees $0.00 0.00%Pennsylvania Premium Tax Assessments $0.00 0.00%Risk Adjustment User Fee $0.18 0.03%Total $14.27 2.66%

Total Non-Benefit Expenses, Risk and Profit $93.61 17.47% 15.85%

Milliman


Development of Administrative Costs Excluding Exchange User Fees Factor

(c)/(c-a+b) Administrative Costs Excluding Exchange User Fees 1.147(a) Non-Benefit Expenses, Risk and Profit (App 12.2) $93.43(b) Pennsylvania Exchange Fee (App 12.2) $17.71(c) Premium (App 15.1) $590.41

Milliman

Appendix 13.1


Plan Adjusted Index Rate to Calibrated Plan-Adjusted Index Rate

(15) (16) (17) (18) (19) = (20) = (15) / (19)(16) * (17) * (18)

Calibrated

Plan Adjusted Geographic Age Tobacco Use Plan-Adjusted

Plan ID Plan Name Index Rate Calibration Factor Calibration Factor1 Calibration Factor Calibration2Index Rate3

86199PA0010025 Ambetter Secure Care 5 (2020) $702.08 1.0000 1.729 1.006 1.739 $403.83

86199PA0010005 Ambetter Balanced Care 5 (2020) 642.81 1.0000 1.729 1.006 1.739 369.74





86199PA0010002 Ambetter Essential Care 1 (2020) 483.65 1.0000 1.729 1.006 1.739 278.20

86199PA0010022 Ambetter Essential Care 2 HSA (2020) 517.21 1.0000 1.729 1.006 1.739 297.50

86199PA0010024 Ambetter Essential Care 4 HSA (2020) 526.98 1.0000 1.729 1.006 1.739 303.12

86199PA0010006 Ambetter Essential Care 10 (2020) 507.50 1.0000 1.729 1.006 1.739 291.91

86199PA0020025 Ambetter Secure Care 5 (2020) + Vision + Adult Dental 735.05 1.0000 1.729 1.006 1.739 422.80

86199PA0020005 Ambetter Balanced Care 5 (2020) + Vision + Adult Dental 673.00 1.0000 1.729 1.006 1.739 387.11





86199PA0020002 Ambetter Essential Care 1 (2020) + Vision + Adult Dental 506.36 1.0000 1.729 1.006 1.739 291.26

86199PA0020006 Ambetter Essential Care 10 (2020) + Vision + Adult Dental 531.33 1.0000 1.729 1.006 1.739 305.62

Total $590.41 1.0000 1.729 1.006 1.739 $339.60

Notes:1) This is the adjustment to go from the true composite average age factor to an age factor 1.0 basis. The rounded weighted average age is 49.2) The calibration value is the product of the geographic calibration factor (1.000), the age calibration factor (1.729), and the tobacco use calibration factor (1.006).3) This is calibrated to an age factor of 1.0, a geographic factor of 1.0, and a tobacco use factor of 1.0. It can be multiplied by the appropriate area, age and tobacco use factors from Appendix 1.3 to closely mirror the Consumer Adjusted Premium Rate.

Milliman


Age Factor Development

Age Band

ProjectedMemberMonths

Composite CMSProposed Relativity

Under 19 1,618 0.788

19-24 7,249 0.98525-29 13,659 1.05630-34 13,060 1.17835-39 10,304 1.24040-44 10,604 1.33245-49 10,005 1.57050-54 13,000 1.95655-59 14,078 2.43060-64 16,475 2.870Over 65 1,977 3.000

Total 112,029 1.729

The rounded weighted average age is 49.

Milliman


Area Factor Development

RegionsProjected Member

MonthsEHB Paid PMPM Area Factor

Pennsylvania Rating Area 8 112,029 $440.83 1.0000Total 112,029 $440.83 1.0000

Milliman


Smoker Factor Development

Premium Rate Projected Member

Months Adjustment FactorTobacco User 4,214 1.150Non-Tobacco User 107,815 1.000

Total 112,029 1.006

Milliman


Projected MLR Table

a) Incurred Claims $447.23b) Risk Adjustment Transfer $54.57c) Projected Claims for MLR (a+b) $501.80d) Administrative Expenses $41.51e) Post-Tax Profit and Contribution to Surplus $10.33f) Taxes and Fees $31.98g) Federal Income Tax $3.17h) State Income Tax $1.60i) Premium (c+d+e+f+g+h) $590.41j) Medical Loss Ratio (c/(i-f-g-h)) 90.6%

This projected MLR is calculated according to 45 CFR 158. The projected MLR is theprojected 2020 calendar year single risk pool experience rather than the three-yearperiod used for determining rebates. No credibility adjustment based on projectedenrollment and average deductible was estimated; including a credibility adjustmentwould increase the projected MLR.

Milliman


AV Calculator Results

The AV Calculator Screenshots have been redacted.

Milliman


Membership Projections

Projected Member MonthsSilver Plan

Product Plan Name Plan ID Gold 70% 73% 87% 94% Bronze Total

Aggregate 1,438 3,655 6,409 30,374 30,314 39,839 112,029

Ambetter Ambetter Secure Care 5 (2020) 86199PA0010025 1,344 - - - - - 1,344Ambetter Ambetter Balanced Care 5 (2020) 86199PA0010005 - 512 718 3,392 4,234 - 8,856Ambetter Ambetter Balanced Care 11 (2020) 86199PA0010004 - 1,970 3,578 14,196 11,847 - 31,591Ambetter Ambetter Balanced Care 12 (2020) 86199PA0010012 - 410 1,137 8,551 11,855 - 21,953Ambetter Ambetter Balanced Care 14 (2020) 86199PA0010014 - 512 538 2,117 279 - 3,446Ambetter Ambetter Balanced Care 15 (2020) 86199PA0010015 - 11 11 11 11 - 44Ambetter Ambetter Essential Care 1 (2020) 86199PA0010002 - - - - - 15,835 15,835Ambetter Ambetter Essential Care 2 HSA (2020) 86199PA0010022 - - - - - 12 12Ambetter Ambetter Essential Care 4 HSA (2020) 86199PA0010024 - - - - - 5,972 5,972Ambetter Ambetter Essential Care 10 (2020) 86199PA0010006 - - - - - 15,828 15,828

Ambetter + Vision + Adult Dental Ambetter Secure Care 5 (2020) + Vision + Adult Dental 86199PA0020025 94 - - - - - 94Ambetter + Vision + Adult Dental Ambetter Balanced Care 5 (2020) + Vision + Adult Dental 86199PA0020005 - 36 51 253 313 - 653Ambetter + Vision + Adult Dental Ambetter Balanced Care 11 (2020) + Vision + Adult Dental 86199PA0020004 - 138 256 1,058 876 - 2,328Ambetter + Vision + Adult Dental Ambetter Balanced Care 12 (2020) + Vision + Adult Dental 86199PA0020012 - 29 81 637 877 - 1,624Ambetter + Vision + Adult Dental Ambetter Balanced Care 14 (2020) + Vision + Adult Dental 86199PA0020014 - 36 38 158 21 - 253Ambetter + Vision + Adult Dental Ambetter Balanced Care 15 (2020) + Vision + Adult Dental 86199PA0020015 - 1 1 1 1 - 4Ambetter + Vision + Adult Dental Ambetter Essential Care 1 (2020) + Vision + Adult Dental 86199PA0020002 - - - - - 1,096 1,096Ambetter + Vision + Adult Dental Ambetter Essential Care 10 (2020) + Vision + Adult Dental 86199PA0020006 - - - - - 1,096 1,096

Milliman


Terminated Plans

Terminated 2019 Plan ID Terminated 2019 Plan Name Mapped 2020 Plan ID Mapped 2020 Plan Name86199PA0010003 Ambetter Balanced Care 3 (2019) 86199PA0010014 Ambetter Balanced Care 14 (2020)86199PA0010001 Ambetter Secure Care 1 (2019) with 3 Free PCP Visits 86199PA0010025 Ambetter Secure Care 5 (2020)

Milliman


Development of Single Risk Pool Projection Factors

Trend Adjustments Util Trend Adj Induced Util Trend

StartingManual Data Cost Adj

RatingRegion -

CostTotal

Cost Adj

RatingRegion -

UtilUtilizationTrend Adj

CalibrationAdj

Prior Auth. / DUR /Disease

Management Adj Total Util AdjInduced UtilAdjustments

After InitialAdj

Impact ofTrend

AdjustmentInpatient Hospital 79.35 1.145 1.088 1.246 1.196 1.051 0.928 1.000 1.165 0.949 109.38 1.378Outpatient Hospital 76.81 0.993 1.177 1.168 1.073 1.051 0.928 1.000 1.045 0.945 88.66 1.154Professional 100.41 1.081 1.094 1.182 1.120 1.049 0.927 1.000 1.089 0.945 122.16 1.217Other Medical 9.76 0.833 1.180 0.983 1.034 1.051 0.928 1.000 1.007 0.891 8.61 0.882Capitation 1.73 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.73 1.000Prescription Drug 97.07 1.057 1.078 1.140 1.120 1.037 0.928 0.941 1.014 0.955 107.15 1.104Total 365.14 1.063 1.106 1.125 1.046 0.928 0.985 0.948 437.70 1.199

Milliman

Inpatient HospitalOutpatient HospitalProfessionalOther MedicalCapitationPrescription DrugTotal



Morbidity Adjustments Demo Adjustments

ClaimsMargin

Change inMorbidity -

Cost


Util

Change inMorbidity - UtilIndiv Mandate

AfterMorbidity

Impact ofMorbidity

Adjustments

Change inDemographics -

Cost


UtilAfter

Demographics

Impact ofInitial DemoAdjustments

1.000 1.000 1.047 1.060 121.40 1.110 1.013 1.178 144.92 1.1941.000 1.000 1.047 1.060 98.40 1.110 1.040 1.203 123.14 1.2511.000 1.000 1.047 1.060 135.58 1.110 1.005 1.129 153.95 1.1351.000 1.000 1.047 1.060 9.56 1.110 0.982 1.186 11.13 1.1641.000 1.000 1.000 1.000 1.73 1.000 1.000 1.000 1.73 1.0001.000 1.000 1.025 1.060 116.46 1.087 1.004 1.270 148.50 1.275

483.14 1.104 583.37 1.207

Milliman

Inpatient HospitalOutpatient HospitalProfessionalOther MedicalCapitationPrescription DrugTotal



Network Adjustments Benefits Adjustments Other AdjustmentsChange inNetwork -

Cost

Change inNetwork -

UtilAfter

Network

Impact ofNetwork

Adjustments

Change inBenefits -

Cost

Change inBenefits -

UtilAfter BenefitAdjustments

Impact ofBenefit

AdjustmentsGracePeriod

Change inOther - Util After Other

Impact ofOther

Adjustments1.000 0.903 130.82 0.903 1.000 0.996 130.26 0.996 1.004 1.000 130.79 1.0041.000 0.889 109.50 0.889 1.000 1.003 109.87 1.003 1.004 1.000 110.31 1.0041.000 0.925 142.47 0.925 1.000 0.961 136.85 0.961 1.004 1.000 137.40 1.0041.000 0.912 10.15 0.912 1.000 0.771 7.83 0.771 1.004 1.000 7.86 1.0041.000 1.000 1.73 1.000 1.000 1.000 1.73 1.000 1.000 1.000 1.73 1.0001.000 1.000 148.50 1.000 1.000 1.000 148.50 1.000 1.004 1.000 149.10 1.004

543.17 0.931 535.04 0.985 537.19 1.004

Milliman


Sample Producer Agreement

Appendix 20.2 has been redacted.

Milliman


Induced Utilization Buildup

(1) (2) (3) (4) (5) (6) (7) (8) (9)= (8) / (6 * 7)

Projected Projected Projected Paid to Allowed Average AV & Cost-Sharing InducedPlan ID Metal Level Membership Allowed Claims Paid Claims Factor Tobacco Factor Factor Utilization86199PA0010025 Gold 1,344 $803,834.95 $708,921.29 0.882 0.994 0.975 1.11286199PA0010005 Silver 8,856 4,799,423.73 4,276,950.12 0.891 0.994 0.893 1.00886199PA0010004 Silver 31,591 17,231,597.80 15,072,071.19 0.875 0.994 0.882 1.01486199PA0010012 Silver 21,953 11,945,259.78 10,334,892.79 0.865 0.994 0.871 1.01286199PA0010014 Silver 3,446 1,885,246.10 1,780,553.55 0.944 0.994 0.956 1.01786199PA0010015 Silver 44 24,695.14 22,685.99 0.919 0.994 0.954 1.04486199PA0010002 Bronze 15,835 8,266,262.26 5,753,914.87 0.696 0.994 0.672 0.97186199PA0010022 Bronze 12 6,498.50 4,662.92 0.718 0.994 0.719 1.00786199PA0010024 Bronze 5,972 3,264,277.23 2,364,418.18 0.724 0.994 0.732 1.01786199PA0010006 Bronze 15,828 8,294,830.68 6,034,964.97 0.728 0.994 0.705 0.97586199PA0020025 Gold 94 56,220.60 49,582.29 0.882 0.994 0.975 1.11286199PA0020005 Silver 653 353,887.05 315,362.29 0.891 0.994 0.893 1.00886199PA0020004 Silver 2,328 1,269,828.74 1,110,689.18 0.875 0.994 0.882 1.01486199PA0020012 Silver 1,624 883,665.19 764,536.32 0.865 0.994 0.871 1.01286199PA0020014 Silver 253 138,411.86 130,725.49 0.944 0.994 0.956 1.01786199PA0020015 Silver 4 2,245.01 2,062.36 0.919 0.994 0.954 1.04486199PA0020002 Bronze 1,096 572,139.15 398,250.12 0.696 0.994 0.672 0.97186199PA0020006 Bronze 1,096 574,370.38 417,887.39 0.728 0.994 0.705 0.975Total 112,029 $60,372,694.14 $49,543,131.32 0.821 0.994 0.818 1.002

Milliman


AV & Cost Sharing Factor Buildup

(1) (2) (3) (4) (5) (6) = (7) (8) (9) = (10) (11) =(4) * (5) (6) / (7 * 8) (6) / (10)

Aggregate Actuarial Value Tobacco InducedProjected Current Paid to Allowed AV & Cost-Sharing and Cost-Sharing Paid to Allowed Calibration Induced Calibration AV & Cost-Sharing

Plan ID Membership Membership Ratio Relativity Design of the Plan Ratio Factor Utilization Factor (1) Factor86199PA0010025 1,344 24 0.821 1.1927 0.979 0.882 0.994 1.116 1.003 0.97586199PA0010005 8,856 192 0.821 1.0921 0.896 0.891 0.994 1.011 1.003 0.89386199PA0010004 31,591 990 0.821 1.0788 0.885 0.875 0.994 1.018 1.003 0.88286199PA0010012 21,953 - 0.821 1.0645 0.874 0.865 0.994 1.015 1.003 0.87186199PA0010014 3,446 17 0.821 1.1684 0.959 0.944 0.994 1.021 1.003 0.95686199PA0010015 44 - 0.821 1.1659 0.957 0.919 0.994 1.047 1.003 0.95486199PA0010002 15,835 646 0.821 0.8217 0.674 0.696 0.994 0.974 1.003 0.67286199PA0010022 12 - 0.821 0.8787 0.721 0.718 0.994 1.011 1.003 0.71986199PA0010024 5,972 - 0.821 0.8953 0.735 0.724 0.994 1.020 1.003 0.73286199PA0010006 15,828 - 0.821 0.8622 0.708 0.728 0.994 0.978 1.003 0.70586199PA0020025 94 - 0.821 1.1927 0.979 0.882 0.994 1.116 1.003 0.97586199PA0020005 653 - 0.821 1.0921 0.896 0.891 0.994 1.011 1.003 0.89386199PA0020004 2,328 - 0.821 1.0788 0.885 0.875 0.994 1.018 1.003 0.88286199PA0020012 1,624 - 0.821 1.0645 0.874 0.865 0.994 1.015 1.003 0.87186199PA0020014 253 - 0.821 1.1684 0.959 0.944 0.994 1.021 1.003 0.95686199PA0020015 4 - 0.821 1.1659 0.957 0.919 0.994 1.047 1.003 0.95486199PA0020002 1,096 - 0.821 0.8217 0.674 0.696 0.994 0.974 1.003 0.67286199PA0020006 1,096 - 0.821 0.8622 0.708 0.728 0.994 0.978 1.003 0.705Total 112,029 1,869 0.821 1.0000 0.821 0.821 0.994 1.003 1.003 0.818

(1) Induced Calibration Factor set to normalize Induced Utilization Value in Table B (Appendix 20.3) to a 1.000 value when weighted by current membership.

Milliman


Description of Benefit Changes

Balanced Care 5 (2020) - 73% AV Level Silver Plan2020 2019

Combined Deductible $5,500 $5,350OOP Max $5,500 $5,350

Balanced Care 11 (2020) - Standard Silver On Exchange Plan2020 2019

OOP Max $8,100 $7,900


Combined Deductible $3,250 $2,625OOP Max $6,500 $6,300Specialist Visit Copay $50 $40


OOP Max $2,700 $2,600Primary Care Visit Copay $8 $7Specialist Visit Copay $15 $10MH/SA (Excluding IP) Copay $8 $7Rx - Generics Copay $8 $7


OOP Max $1,050 $1,000

Essential Care 1 (2020) - Standard Bronze On Exchange Plan2020 2019

Combined Deductible $8,150 $7,900OOP Max $8,150 $7,900

Milliman


Capital, Surplus and RBC

Milliman

ANNUAL STATEMENT FOR THE YEAR 2018 OF THE Pennsylvania Health & Wellness, Inc.

ASSETSCurrent Year Prior Year

1

Assets

2

Nonadmitted Assets

3

Net Admitted Assets(Cols. 1 - 2)

4

Net AdmittedAssets

1. Bonds (Schedule D) 6,896,996 6,896,996 109,554

2. Stocks (Schedule D):

2.1 Preferred stocks 0 0 0

2.2 Common stocks 0 0 0

3. Mortgage loans on real estate (Schedule B):

3.1 First liens 0 0

3.2 Other than first liens 0 0

4. Real estate (Schedule A):

4.1 Properties occupied by the company (less

$ encumbrances) 0 0

4.2 Properties held for the production of income

(less $ encumbrances) 0 0

4.3 Properties held for sale (less

$ encumbrances) 0 0

5. Cash ($ 1,197,455 , Schedule E-Part 1), cash equivalents

($ 20,613,911 , Schedule E-Part 2) and short-term

investments ($ 1,936,896 , Schedule DA) 23,748,262 23,748,262 1,500,756

6. Contract loans (including $ premium notes) 0 0

7. Derivatives (Schedule DB) 0 0 0

8. Other invested assets (Schedule BA) 0 0 0

9. Receivables for securities 0 0

10. Securities lending reinvested collateral assets (Schedule DL) 0 0

11. Aggregate write-ins for invested assets 0 0 0 0

12. Subtotals, cash and invested assets (Lines 1 to 11) 30,645,257 0 30,645,257 1,610,310

13. Title plants less $ charged off (for Title insurers

only) 0 0

14. Investment income due and accrued 56,287 56,287 633

15. Premiums and considerations:

15.1 Uncollected premiums and agents’ balances in the course of

collection 62,267,587 62,267,587 0

15.2 Deferred premiums, agents’ balances and installments booked but

deferred and not yet due (including $ earned

but unbilled premiums) 0 0

15.3 Accrued retrospective premiums ($ 83,976 ) and

contracts subject to redetermination ($ ) 83,976 83,976 0

16. Reinsurance:

16.1 Amounts recoverable from reinsurers 0 0

16.2 Funds held by or deposited with reinsured companies 0 0

16.3 Other amounts receivable under reinsurance contracts 0 0

17. Amounts receivable relating to uninsured plans 0 0

18.1 Current federal and foreign income tax recoverable and interest thereon 0 0

18.2 Net deferred tax asset 930,290 930,290 0

19. Guaranty funds receivable or on deposit 0 0

20. Electronic data processing equipment and software 0 0

21. Furniture and equipment, including health care delivery assets

($ ) 0 0

22. Net adjustment in assets and liabilities due to foreign exchange rates 0 0

23. Receivables from parent, subsidiaries and affiliates 30,269,144 30,269,144 0

24. Health care ($ 1,486,268 ) and other amounts receivable 2,330,633 844,365 1,486,268 0

25. Aggregate write-ins for other-than-invested assets 2,101,188 1,506,940 594,248 0

26. Total assets excluding Separate Accounts, Segregated Accounts and

Protected Cell Accounts (Lines 12 to 25) 128,684,362 2,351,305 126,333,057 1,610,943

27. From Separate Accounts, Segregated Accounts and Protected

Cell Accounts 0 0

28. Total (Lines 26 and 27) 128,684,362 2,351,305 126,333,057 1,610,943

DETAILS OF WRITE-INS

1101.

1102.

1103.

1198. Summary of remaining write-ins for Line 11 from overflow page 0 0 0 0

1199. Totals (Lines 1101 through 1103 plus 1198) (Line 11 above) 0 0 0 0

2501. Prepaid Assets 2,101,188 1,506,940 594,248 0

2502. 0 0

2503.


2599. Totals (Lines 2501 through 2503 plus 2598) (Line 25 above) 2,101,188 1,506,940 594,248 0

2


LIABILITIES, CAPITAL AND SURPLUSCurrent Year Prior Year

1Covered

2Uncovered

3Total

4Total

1. Claims unpaid (less $ reinsurance ceded) 37,407,125 37,407,125 0

2. Accrued medical incentive pool and bonus amounts 960 960 0

3. Unpaid claims adjustment expenses 558,000 558,000 0

4. Aggregate health policy reserves, including the liability of

$ 79,662 for medical loss ratio rebate per the Public

Health Service Act 1,562,062 1,562,062 0

5. Aggregate life policy reserves 0 0

6. Property/casualty unearned premium reserves 0 0

7. Aggregate health claim reserves 0 0

8. Premiums received in advance 146,498 146,498 0

9. General expenses due or accrued 527,254 527,254 0

10.1 Current federal and foreign income tax payable and interest thereon (including

$ on realized capital gains (losses)) 456,096 456,096 0

10.2 Net deferred tax liability 0 0

11. Ceded reinsurance premiums payable 0 0

12. Amounts withheld or retained for the account of others 0 0

13. Remittances and items not allocated 0 0

14. Borrowed money (including $ current) and

interest thereon $ (including

$ current) 0 0

15. Amounts due to parent, subsidiaries and affiliates 2,341,076 2,341,076 0

16. Derivatives 0 0 0

17. Payable for securities 0 0

18. Payable for securities lending 0 0

19. Funds held under reinsurance treaties (with $

authorized reinsurers, $ unauthorized

reinsurers and $ certified reinsurers) 0 0

20. Reinsurance in unauthorized and certified ($ )

companies 0 0

21. Net adjustments in assets and liabilities due to foreign exchange rates 0 0

22. Liability for amounts held under uninsured plans 153,377 153,377 0

23. Aggregate write-ins for other liabilities (including $ 14,450,117

current) 14,450,355 0 14,450,355 0

24. Total liabilities (Lines 1 to 23) 57,602,803 0 57,602,803 0

25. Aggregate write-ins for special surplus funds XXX XXX 0 0

26. Common capital stock XXX XXX 0

27. Preferred capital stock XXX XXX 0

28. Gross paid in and contributed surplus XXX XXX 68,609,528 1,609,528

29. Surplus notes XXX XXX 0

30. Aggregate write-ins for other-than-special surplus funds XXX XXX 0 0

31. Unassigned funds (surplus) XXX XXX 120,727 1,415

32. Less treasury stock, at cost:

32.1 shares common (value included in Line 26

$ ) XXX XXX 0

32.2 shares preferred (value included in Line 27

$ ) XXX XXX 0

33. Total capital and surplus (Lines 25 to 31 minus Line 32) XXX XXX 68,730,255 1,610,943

34. Total liabilities, capital and surplus (Lines 24 and 33) XXX XXX 126,333,058 1,610,943

DETAILS OF WRITE-INS

2301. State Assessment Payable 13,903,782 13,903,782 0

2302. State Income Tax Payable 546,573 546,573 0

2303.


2399. Totals (Lines 2301 through 2303 plus 2398) (Line 23 above) 14,450,355 0 14,450,355 0

2501. XXX XXX 0

2502. XXX XXX

2503. XXX XXX

2598. Summary of remaining write-ins for Line 25 from overflow page XXX XXX 0 0

2599. Totals (Lines 2501 through 2503 plus 2598) (Line 25 above) XXX XXX 0 0

3001. XXX XXX

3002. XXX XXX

3003. XXX XXX

3098. Summary of remaining write-ins for Line 30 from overflow page XXX XXX 0 0

3099. Totals (Lines 3001 through 3003 plus 3098) (Line 30 above) XXX XXX 0 0

3


FIVE - YEAR HISTORICAL DATA1

20182

20173

20164

20155

2014

Balance Sheet (Pages 2 and 3)

1. Total admitted assets (Page 2, Line 28) 126,333,057 1,610,943 1,500,000 0 0

2. Total liabilities (Page 3, Line 24) 57,602,803 0 0 0 0

3. Statutory minimum capital and surplus requirement 68,730,255 1,500,000 1,500,000 0 0

4. Total capital and surplus (Page 3, Line 33) 68,730,255 1,610,943 1,500,000 0 0

Income Statement (Page 4)

5. Total revenues (Line 8) 483,429,037 0 0 0 0

6. Total medical and hospital expenses (Line 18) 464,941,113 0 0 0 0

7. Claims adjustment expenses (Line 20) 7,189,518 0 0 0 0

8. Total administrative expenses (Line 21) 7,751,399 0 0 0 0

9. Net underwriting gain (loss) (Line 24) 2,064,607 0 0 0 0

10. Net investment gain (loss) (Line 27) 444,399 1,415 0 0 0

11. Total other income (Lines 28 plus 29) (2,433) 0 0 0 0

12. Net income or (loss) (Line 32) 1,540,324 1,415 0 0 0

Cash Flow (Page 6)

13. Net cash from operations (Line 11) (7,966,505) 610 0 0 0

Risk-Based Capital Analysis

14. Total adjusted capital 68,730,255 1,610,943 1,500,000 0 0

15. Authorized control level risk-based capital 18,690,515 2,799 2,250 0 0

Enrollment (Exhibit 1)

16. Total members at end of period (Column 5, Line 7) 22,780 0 0 0 0

17. Total members months (Column 6, Line 7) 267,278 0 0 0 0

Operating Percentage (Page 4)

(Item divided by Page 4, sum of Lines 2, 3, and 5) x 100.0

18. Premiums earned plus risk revenue (Line 2 plus Lines 3and 5) 100.0 100.0 100.0 100.0 100.0

19. Total hospital and medical plus other non-health (Lines18 plus Line 19) 96.2 0.0 0.0 0.0 0.0

20. Cost containment expenses 0.0 0.0 0.0 0.0 0.0

21. Other claims adjustment expenses 1.5 0.0 0.0 0.0 0.0

22. Total underwriting deductions (Line 23) 99.6 0.0 0.0 0.0 0.0

23. Total underwriting gain (loss) (Line 24) 0.4 0.0 0.0 0.0 0.0

Unpaid Claims Analysis

(U&I Exhibit, Part 2B)

24. Total claims incurred for prior years (Line 13, Col. 5) 0 0 0 0 0

25. Estimated liability of unpaid claims – [prior year (Line 13,Col. 6)] 0 0 0 0 0

Investments In Parent, Subsidiaries and Affiliates

26. Affiliated bonds (Sch. D Summary, Line 12, Col. 1) 0 0 0 0 0

27. Affiliated preferred stocks (Sch. D Summary, Line 18,Col. 1) 0 0 0 0 0

28. Affiliated common stocks (Sch. D Summary, Line 24,Col. 1) 0 0 0 0 0

29. Affiliated short-term investments (subtotal included inSch. DA Verification, Col. 5, Line 10) 0 0 0 0 0

30. Affiliated mortgage loans on real estate 0 0 0 0

31. All other affiliated 0 0 0 0 0

32. Total of above Lines 26 to 31 0 0 0 0 0

33. Total investment in parent included in Lines 26 to 31above

NOTE: If a party to a merger, have the two most recent years of this exhibit been restated due to a merger in compliance with the disclosure requirementsof SSAP No. 3 - Accounting Changes and Correction of Errors? Yes [ ] No [ ]

If no, please explain

29

Milliman (Health Cost Guidelines ),Pennsylvania Health & Wellness, Inc.

Unit Cost trends Pennsylvania Health & Wellness, Inc.Administrative Costs, Taxes, and Fees Pennsylvania Health & Wellness, Inc.Premium Delinquency Estimates Pennsylvania Health & Wellness, Inc.Subcapitated Contracts and Pricing Pennsylvania Health & Wellness, Inc.Value Added Benefits Pennsylvania Health & Wellness, Inc.Smoking Relativity Factors Pennsylvania Health & Wellness, Inc.County Rating Areas Pennsylvania Health & Wellness, Inc.Pennsylvania Health & Wellness, Inc. Service Areas Pennsylvania Health & Wellness, Inc.Expected Reimbursement by Rating Area and State Pennsylvania Health & Wellness, Inc.OON Utilization and Reimbursement Pennsylvania Health & Wellness, Inc.Utilization Management Pennsylvania Health & Wellness, Inc.3:1 Age Band Factors HHSPrescription Drug Assumptions: AWP Discount, Dispensing Fee, Rebates, Retail/Mail Utilization percentages, formularies, and Rx Management Assumptions Envolve

Documentation of MCO AssessmentPennsylvania Health & Wellness, Inc. and Pennsylvania Department of Human Services

Funding Status of CSR Subsidies Pennsylvania Health & Wellness, Inc.CSR Silver Loading Methodology Pennsylvania 2020 ACA-Compliant Health Insurance Rate Filing Guidance

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Data and Assumption Reliance for 2020 Individual Marketplace Premium Development

Data / Assumption SourceRelevant 2018 Individual QHP experience from other states Pennsylvania Health & Wellness, Inc.2020 Population Morbidity, including the impact of individual mandate repeal Pennsylvania Health & Wellness, Inc.Impact of individual mandate repeal Pennsylvania 2020 ACA-Compliant Health Insurance Rate Filing GuidanceCSR non-funding rate and risk transfer impacts Pennsylvania 2020 ACA-Compliant Health Insurance Rate Filing Guidance2020 Statewide Average Premium Pennsylvania Health & Wellness, Inc.2020 Individual QHP Membership Projections Pennsylvania Health & Wellness, Inc.Relationship between enrollee duration and paid-to-allowed ratio by metal level Pennsylvania Health & Wellness, Inc.Pricing and Premium Development Models MillimanBasic tables of utilization, cost, claims probability distributions, pricing adjustment factors, and primarycare/specialty care utilization distribution Milliman (Health Cost Guidelines )2020 Individual QHP Benefit Designs Pennsylvania Health & Wellness, Inc.

Utilization trends

2020 Rates Table Template v9.0 All fields with an asterisk ( * ) are required. To validate press Validate button or Ctrl + Shift + I. To finalize, press Finalize button or Ctrl + Shift + F.

If macros are disabled, press and hold the ALT key and press the F, then I, and then N key. After that, select the Enable All Content option by pressing enter. (note that you can also press the C key to select "Enable All Content") Instructions can be found in cells B1 through B5.If you are in a community rating state, select Family-Tier Rates under Rating Method and fill in all columns.If you are not in a community rating state, select Age-Based Rates under Rating Method and provide an Individual Rate for every age band.If Tobacco is Tobacco User/Non-Tobacco User, you must give a rate for Tobacco Use and Non-Tobacco Use.To add a new sheet, press the Add Sheet button, or Ctrl + Shift + H. All plans must have the same dates on a sheet.

HIOS Issuer ID* 86199Federal TIN* 47-5340613

Rate Effective Date* 1/1/2020Rate Expiration Date* 12/31/2020

Rating Method* Age-Based Rates

Plan ID* Rating Area ID* Tobacco* Age* Individual Rate* Individual Tobacco Rate*

Required:Enter the 14-character Plan ID

Required:Select the Rating Area ID

Required:Select if Tobacco use of subscriber is used to

determine if a person is eligible for a rate from a plan

Required:Select the age of a subscriber eligible for the

rate

Required:Enter the rate of an Individual Non-Tobacco or

No Preference enrollee on a plan

Required:Enter the rate of an Individual tobacco enrollee

on a plan

86199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 0-14 308.93 308.9386199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 15 336.39 336.3986199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 16 346.89 346.8986199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 17 357.39 357.3986199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 18 368.70 424.0086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 19 380.00 437.0086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 20 391.72 450.4786199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 21 403.84 464.4186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 22 403.84 464.4186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 23 403.84 464.4186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 24 403.84 464.4186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 25 405.45 466.2686199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 26 413.52 475.5586199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 27 423.21 486.7086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 28 438.96 504.8186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 29 451.89 519.6786199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 30 458.35 527.1086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 31 468.04 538.2486199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 32 477.73 549.3986199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 33 483.79 556.3686199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 34 490.25 563.7986199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 35 493.48 567.5086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 36 496.71 571.2286199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 37 499.94 574.9386199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 38 503.17 578.6586199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 39 509.63 586.0886199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 40 516.09 593.5186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 41 525.79 604.6586199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 42 535.07 615.3486199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 43 548.00 630.2086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 44 564.15 648.7786199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 45 583.13 670.6086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 46 605.75 696.6186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 47 631.19 725.8686199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 48 660.26 759.3086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 49 688.93 792.2786199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 50 721.24 829.4386199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 51 753.14 866.1186199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 52 788.28 906.5286199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 53 823.81 947.3986199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 54 862.18 991.5086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 55 900.54 1035.6286199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 56 942.14 1083.4686199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 57 984.13 1131.7586199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 58 1028.96 1183.3086199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 59 1051.17 1208.8486199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 60 1095.99 1260.3986199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 61 1134.76 1304.9886199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 62 1160.20 1334.2386199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 63 1192.11 1370.9286199PA0010025 Rating Area 8 Tobacco User/Non-Tobacco User 64 and over 1211.48 1393.2086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 0-14 282.85 282.8586199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 15 307.99 307.9986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 16 317.61 317.6186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 17 327.22 327.2286199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 18 337.57 388.2186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 19 347.93 400.1186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 20 358.65 412.4486199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 21 369.75 425.2186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 22 369.75 425.2186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 23 369.75 425.2186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 24 369.75 425.2186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 25 371.22 426.9086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 26 378.61 435.4186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 27 387.49 445.6186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 28 401.91 462.1986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 29 413.74 475.8086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 30 419.65 482.6086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 31 428.53 492.8186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 32 437.40 503.0186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 33 442.95 509.3986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 34 448.86 516.1986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 35 451.82 519.6086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 36 454.78 523.0086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 37 457.74 526.4086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 38 460.70 529.8086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 39 466.61 536.6086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 40 472.53 543.4186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 41 481.40 553.6186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 42 489.91 563.3986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 43 501.74 577.0086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 44 516.53 594.0186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 45 533.90 613.9986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 46 554.61 637.8086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 47 577.90 664.5986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 48 604.52 695.2086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 49 630.78 725.3986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 50 660.36 759.4186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 51 689.57 793.0086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 52 721.73 829.9986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 53 754.27 867.4186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 54 789.39 907.8086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 55 824.52 948.2086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 56 862.60 991.9986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 57 901.06 1036.2186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 58 942.10 1083.4186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 59 962.43 1106.8086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 60 1003.47 1154.0086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 61 1038.97 1194.8186199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 62 1062.26 1221.6086199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 63 1091.47 1255.1986199PA0010005 Rating Area 8 Tobacco User/Non-Tobacco User 64 and over 1109.21 1275.5986199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 0-14 279.43 279.4386199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 15 304.27 304.2786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 16 313.76 313.7686199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 17 323.26 323.2686199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 18 333.49 383.5186199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 19 343.72 395.2786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 20 354.31 407.4586199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 21 365.28 420.0786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 22 365.28 420.0786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 23 365.28 420.0786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 24 365.28 420.0786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 25 366.73 421.7486199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 26 374.03 430.1486199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 27 382.80 440.2286199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 28 397.04 456.6086199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 29 408.73 470.0486199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 30 414.58 476.7686199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 31 423.34 486.8486199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 32 432.11 496.9386199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 33 437.59 503.2386199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 34 443.43 509.9586199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 35 446.36 513.3186199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 36 449.28 516.6786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 37 452.20 520.0386199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 38 455.12 523.3986199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 39 460.97 530.1186199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 40 466.81 536.8386199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 41 475.58 546.9186199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 42 483.98 556.5786199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 43 495.67 570.0286199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 44 510.28 586.8286199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 45 527.44 606.5686199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 46 547.90 630.0886199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 47 570.91 656.5586199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 48 597.21 686.7986199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 49 623.14 716.6286199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 50 652.37 750.2286199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 51 681.22 783.4086199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 52 713.00 819.9586199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 53 745.14 856.9186199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 54 779.84 896.8286199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 55 814.54 936.7386199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 56 852.17 979.9986199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 57 890.15 1023.6886199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 58 930.70 1070.3086199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 59 950.79 1093.41

86199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 60 991.33 1140.0386199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 61 1026.40 1180.3686199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 62 1049.41 1206.8286199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 63 1078.27 1240.0186199PA0010004 Rating Area 8 Tobacco User/Non-Tobacco User 64 and over 1095.79 1260.1686199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 0-14 275.72 275.7286199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 15 300.23 300.2386199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 16 309.60 309.6086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 17 318.97 318.9786199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 18 329.07 378.4386199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 19 339.16 390.0386199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 20 349.61 402.0586199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 21 360.43 414.5086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 22 360.43 414.5086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 23 360.43 414.5086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 24 360.43 414.5086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 25 361.86 416.1486199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 26 369.07 424.4386199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 27 377.72 434.3886199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 28 391.78 450.5586199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 29 403.31 463.8186199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 30 409.08 470.4486199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 31 417.73 480.3986199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 32 426.38 490.3486199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 33 431.79 496.5586199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 34 437.55 503.1986199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 35 440.44 506.5086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 36 443.32 509.8286199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 37 446.20 513.1386199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 38 449.09 516.4586199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 39 454.85 523.0886199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 40 460.62 529.7186199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 41 469.27 539.6686199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 42 477.56 549.1986199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 43 489.09 562.4686199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 44 503.51 579.0486199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 45 520.45 598.5286199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 46 540.63 621.7386199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 47 563.34 647.8486199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 48 589.29 677.6886199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 49 614.88 707.1186199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 50 643.71 740.2786199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 51 672.19 773.0286199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 52 703.54 809.0886199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 53 735.26 845.5586199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 54 769.50 884.9386199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 55 803.74 924.3086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 56 840.87 967.0086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 57 878.35 1010.1086199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 58 918.36 1056.1186199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 59 938.18 1078.9186199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 60 978.19 1124.9186199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 61 1012.79 1164.7186199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 62 1035.49 1190.8286199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 63 1063.97 1223.5686199PA0010012 Rating Area 8 Tobacco User/Non-Tobacco User 64 and over 1081.26 1243.45

86199PA0010014 Rating Area 8 Tobacco User/Non-Tobacco User0-14

302.62 302.62

86199PA0010014 Rating Area 8 Tobacco User/Non-Tobacco User15

329.52 329.52


339.81 339.81


350.09 350.09


361.17 415.34


372.25 428.08


383.72 441.27


395.59 454.93


395.59 454.93


395.59 454.93


395.59 454.93


397.17 456.74


405.08 465.84


414.57 476.76


430.00 494.50


442.66 509.06


448.99 516.34


458.48 527.26


467.98 538.17


473.91 545.00


480.24 552.28


483.40 555.92


486.57 559.55


489.73 563.19


492.90 566.83


499.23 574.11


505.56 581.39


515.05 592.31


524.15 602.77


536.81 617.33


552.63 635.53


571.22 656.91


593.38 682.38


618.30 711.04


646.78 743.80


674.87 776.10


706.51 812.49


737.77 848.43


772.18 888.01


806.99 928.04


844.57 971.26


882.15 1014.48


922.90 1061.33


964.04 1108.65


1007.95 1159.14


1029.71 1184.16


1073.62 1234.66


1111.59 1278.33


1136.52 1306.99


1167.77 1342.93

86199PA0010014 Rating Area 8 Tobacco User/Non-Tobacco User64 and over

1186.74 1364.76


301.97 301.97


328.81 328.81


339.08 339.08


349.34 349.34


360.39 414.45


371.45 427.16


382.89 440.33


394.74 453.95


394.74 453.95


394.74 453.95


394.74 453.95


396.31 455.76


404.21 464.84


413.68 475.73


429.08 493.44


441.71 507.96


448.02 515.23


457.50 526.12


466.97 537.02


472.89 543.83


479.21 551.09


482.37 554.72


485.52 558.35


488.68 561.98


491.84 565.61


498.15 572.88


504.47 580.14


513.94 591.04


523.02 601.48


535.65 616.00


551.44 634.16


570.00 655.50


592.10 680.92


616.97 709.52


645.39 742.20


673.42 774.43


705.00 810.75


736.18 846.61


770.52 886.10


805.26 926.05


842.76 969.17


880.26 1012.30


920.92 1059.05


961.97 1106.26


1005.78 1156.65


1027.49 1181.62


1071.31 1232.01


1109.20 1275.58


1134.07 1304.18


1165.26 1340.04


1184.19 1361.82


212.82 212.82


231.73 231.73


238.97 238.97


246.20 246.20


253.99 292.09


261.78 301.05


269.85 310.32


278.20 319.93


278.20 319.93


278.20 319.93


278.20 319.93


279.31 321.20


284.87 327.60


291.55 335.28


302.40 347.75


311.30 357.99


315.75 363.11


322.42 370.79


329.10 378.47


333.27 383.27


337.73 388.38


339.95 390.94


342.18 393.50


344.40 396.06


346.63 398.62


351.08 403.74


355.53 408.86


362.21 416.54


368.60 423.90


377.51 434.13


388.63 446.93


401.71 461.97


417.29 479.88


434.81 500.04


454.84 523.07


474.60 545.79


496.85 571.38


518.83 596.65


543.03 624.49


567.51 652.64


593.94 683.03


620.37 713.42


649.02 746.38


677.95 779.65


708.83 815.16


724.13 832.75


755.01 868.27


781.72 898.98


799.25 919.13


821.22 944.41


834.57 959.75


227.58 227.58


247.81 247.81


255.55 255.55


263.28 263.28


271.61 312.35


279.94 321.93


288.57 331.85


297.50 342.13


297.50 342.13


297.50 342.13


297.50 342.13


298.68 343.49


304.63 350.33


311.77 358.54


323.37 371.88


332.89 382.83


337.65 388.30


344.79 396.51


351.93 404.72


356.40 409.86


361.16 415.33


363.54 418.07


365.92 420.80


368.30 423.54


370.68 426.28


375.44 431.75


380.20 437.23


387.34 445.44


394.18 453.30


403.70 464.25


415.60 477.94


429.58 494.02


446.24 513.18


464.98 534.73


486.40 559.36


507.52 583.65


531.32 611.02


554.82 638.05


580.71 667.81


606.89 697.92


635.15 730.42


663.41 762.92


694.05 798.16


724.99 833.74


758.01 871.71


774.37 890.53


807.40 928.50


835.95 961.35


854.70 982.90


878.20 1009.93


892.47 1026.34


231.88 231.88


252.49 252.49


260.37 260.37


268.25 268.25


276.74 318.25


285.23 328.01


294.02 338.12


303.12 348.59


303.12 348.59


303.12 348.59


303.12 348.59


304.33 349.97


310.39 356.95


317.66 365.31


329.48 378.91


339.18 390.06


344.03 395.64


351.31 404.00


358.58 412.37


363.13 417.60


367.98 423.18


370.40 425.96


372.83 428.75


375.25 431.54


377.68 434.33


382.53 439.91


387.38 445.48


394.65 453.85


401.62 461.87


411.32 473.02


423.45 486.97


437.69 503.35


454.67 522.87


473.77 544.83


495.59 569.93


517.11 594.68


541.36 622.56


565.31 650.10


591.68 680.43


618.35 711.10


647.15 744.22


675.94 777.33


707.16 813.24


738.69 849.49


772.33 888.18


789.00 907.35


822.65 946.05


851.75 979.51


870.84 1001.47


894.79 1029.01


909.33 1045.73


223.31 223.31


243.16 243.16


250.75 250.75


258.34 258.34


266.51 306.49


274.69 315.89


283.15 325.63


291.92 335.71


291.92 335.71


291.92 335.71


291.92 335.71


293.08 337.04


298.92 343.75


305.92 351.81


317.31 364.90


326.65 375.64


331.32 381.02


338.32 389.07


345.33 397.13


349.71 402.16


354.38 407.54


356.71 410.22


359.05 412.91


361.38 415.59


363.72 418.28


368.39 423.65


373.06 429.02


380.07 437.08


386.78 444.80


396.12 455.54


407.80 468.97


421.52 484.75


437.86 503.54


456.25 524.69


477.27 548.86


498.00 572.70


521.35 599.55


544.41 626.07


569.81 655.28


595.50 684.82


623.23 716.71


650.96 748.60


681.03 783.18


711.38 818.09


743.79 855.35


759.84 873.82


792.24 911.08


820.27 943.31


838.66 964.46


861.72 990.98


875.72 1007.08


323.43 323.43


352.18 352.18


363.18 363.18


374.17 374.17


386.01 443.91


397.85 457.52


410.11 471.62


422.80 486.22


422.80 486.22


422.80 486.22


422.80 486.22


424.48 488.15


432.94 497.88


443.08 509.55


459.57 528.51


473.10 544.07


479.87 551.85


490.01 563.52


500.16 575.19


506.50 582.48


513.27 590.26


516.65 594.15


520.03 598.04


523.41 601.93


526.80 605.82


533.56 613.60


540.33 621.38


550.47 633.04


560.20 644.23


573.73 659.79


590.64 679.23


610.51 702.09


634.19 729.31


660.82 759.94


691.26 794.95


721.28 829.47


755.10 868.37


788.50 906.78


825.29 949.08


862.49 991.87


902.66 1038.06


942.82 1084.25


986.37 1134.33


1030.34 1184.89


1077.27 1238.86


1100.52 1265.60


1147.45 1319.57


1188.04 1366.25


1214.68 1396.88


1248.08 1435.29


1268.36 1458.62


296.13 296.13


322.45 322.45


332.52 332.52


342.58 342.58


353.42 406.44


364.26 418.90


375.49 431.81


387.11 445.18


387.11 445.18


387.11 445.18


387.11 445.18


388.65 446.95


396.39 455.85


405.68 466.53


420.78 483.89


433.16 498.14


439.36 505.26


448.65 515.95


457.94 526.63


463.75 533.31


469.94 540.43


473.04 543.99


476.13 547.55


479.23 551.11


482.33 554.68


488.52 561.80


494.71 568.92


504.00 579.60


512.91 589.84


525.29 604.09


540.78 621.90


558.97 642.82


580.65 667.75


605.04 695.79


632.91 727.84


660.39 759.45


691.36 795.06


721.94 830.23


755.62 868.96


789.68 908.14


826.46 950.43


863.23 992.72


903.10 1038.57


943.36 1084.87


986.33 1134.28


1007.62 1158.76


1050.59 1208.18


1087.75 1250.91


1112.14 1278.96


1142.72 1314.13


1161.29 1335.49


292.55 292.55


318.55 318.55


328.50 328.50


338.44 338.44


349.15 401.52


359.85 413.83


370.94 426.59


382.43 439.79


382.43 439.79


382.43 439.79


382.43 439.79


383.95 441.54


391.59 450.33


400.77 460.89


415.69 478.04


427.92 492.11


434.04 499.15


443.22 509.70


452.40 520.26


458.13 526.85


464.25 533.89


467.31 537.41


470.37 540.93


473.43 544.45


476.49 547.96


482.61 555.00


488.73 562.04


497.91 572.59


506.70 582.71


518.94 596.78


534.24 614.37


552.21 635.04


573.62 659.67


597.72 687.37


625.25 719.04


652.40 750.26


683.00 785.44


713.21 820.19


746.48 858.45


780.13 897.15


816.46 938.93


852.79 980.71


892.18 1026.00


931.95 1071.74


974.40 1120.56


995.43 1144.74


1037.88 1193.56


1074.59 1235.78


1098.68 1263.48


1128.89 1298.23


1147.24 1319.33


288.67 288.67


314.33 314.33


324.14 324.14


333.95 333.95


344.52 396.19


355.08 408.34


366.02 420.93


377.36 433.96


377.36 433.96


377.36 433.96


377.36 433.96


378.85 435.68


386.40 444.36


395.46 454.78


410.17 471.70


422.25 485.59


428.29 492.53


437.34 502.94


446.40 513.36


452.06 519.87


458.10 526.81


461.12 530.28


464.13 533.75


467.15 537.23


470.17 540.70


476.21 547.64


482.25 554.58


491.30 565.00


499.98 574.98


512.06 588.87


527.15 606.22


544.89 626.62


566.02 650.92


589.79 678.26


616.96 709.50


643.75 740.31


673.94 775.03


703.75 809.31


736.58 847.06


769.78 885.25


805.63 926.48


841.48 967.70


880.35 1012.40


919.59 1057.53


961.48 1105.70


982.23 1129.56


1024.11 1177.73


1060.34 1219.39


1084.11 1246.73


1113.92 1281.01


1132.03 1301.83


316.83 316.83


344.99 344.99


355.76 355.76


366.53 366.53


378.13 434.85


389.72 448.18


401.73 461.99


414.17 476.29


414.17 476.29


414.17 476.29


414.17 476.29


415.81 478.19


424.10 487.71


434.04 499.14


450.19 517.72


463.44 532.96


470.07 540.58


480.01 552.01


489.95 563.44


496.16 570.59


502.79 578.21


506.10 582.02


509.41 585.83


512.73 589.64


516.04 593.45


522.67 601.07


529.29 608.69


539.23 620.12


548.76 631.07


562.01 646.31


578.58 665.37


598.04 687.75


621.24 714.42


647.33 744.43


677.15 778.72


706.55 812.54


739.69 850.64


772.41 888.27


808.44 929.70


844.88 971.62


884.23 1016.86


923.57 1062.11


966.23 1111.17


1009.30 1160.70


1055.28 1213.57


1078.05 1239.76


1124.03 1292.63


1163.78 1338.35


1189.88 1368.36


1222.60 1405.98


1242.46 1428.84


316.15 316.15


344.25 344.25


355.00 355.00


365.74 365.74


377.31 433.91


388.89 447.22


400.87 461.00


413.28 475.27


413.28 475.27


413.28 475.27


413.28 475.27


414.92 477.16


423.19 486.66


433.10 498.07


449.22 516.61


462.45 531.81


469.06 539.42


478.98 550.82


488.90 562.23


495.10 569.36


501.71 576.96


505.01 580.77


508.32 584.57


511.63 588.37


514.93 592.17


521.54 599.78


528.16 607.38


538.07 618.79


547.58 629.72


560.80 644.93


577.34 663.94


596.76 686.27


619.90 712.89


645.94 742.83


675.69 777.05


705.04 810.79


738.10 848.81


770.74 886.36


806.70 927.70


843.07 969.53


882.33 1014.68


921.59 1059.83


964.15 1108.78


1007.13 1158.20


1053.01 1210.96


1075.74 1237.10


1121.61 1289.85


1161.28 1335.48


1187.32 1365.42


1219.97 1402.96


1239.79 1425.76


222.81 222.81


242.61 242.61


250.19 250.19


257.76 257.76


265.91 305.80


274.07 315.18


282.52 324.89


291.26 334.95


291.26 334.95


291.26 334.95


291.26 334.95


292.42 336.28


298.24 342.98


305.23 351.02


316.59 364.08


325.91 374.80


330.57 380.16


337.56 388.20


344.55 396.24


348.92 401.26


353.58 406.62


355.91 409.30


358.24 411.98


360.57 414.66


362.90 417.34


367.56 422.70


372.22 428.06


379.21 436.09


385.91 443.80


395.23 454.52


406.88 467.91


420.57 483.66


436.88 502.41


455.23 523.51


476.20 547.63


496.88 571.41


520.18 598.21


543.19 624.67


568.53 653.81


594.16 683.28


621.83 715.10


649.50 746.92


679.50 781.42


709.79 816.25


742.12 853.43


758.13 871.85


790.46 909.03


818.42 941.19


836.77 962.29


859.78 988.75


873.75 1004.82


233.80 233.80


254.58 254.58


262.52 262.52


270.47 270.47


279.03 320.88


287.58 330.72


296.45 340.91


305.63 351.47


305.63 351.47


305.63 351.47


305.63 351.47


306.84 352.86


312.95 359.89


320.28 368.33


332.20 382.03


341.98 393.28


346.87 398.90


354.21 407.34


361.54 415.77


366.13 421.05


371.02 426.67


373.46 429.48


375.91 432.29


378.35 435.10


380.80 437.92


385.69 443.54


390.58 449.16


397.91 457.60


404.94 465.68


414.72 476.93


426.94 490.99


441.31 507.51


458.42 527.19


477.68 549.33


499.68 574.63


521.38 599.59


545.83 627.70


569.97 655.47


596.56 686.05


623.46 716.97


652.49 750.36


681.52 783.75


713.00 819.95


744.78 856.50


778.71 895.51


795.52 914.84


829.44 953.86


858.78 987.60


878.03 1009.74


902.18 1037.50


916.84 1054.36

June 24, 2019

Pennsylvania Insurance Department1311 Strawberry SquareHarrisburg, PA 17120

Re: Response to Objections Received 6/18/2019 – Changes Made to Filing Items

Ms. Gray,

As a part of the response to the objections letter from the Pennsylvania Insurance Department, sent on6/18/2019, below is a list of the changes made to the filing items and the reasons why the changes weremade.

1) 2020_PHW_Actuarial_Memo_20190624a. Updated the language in the paragraph labeled “Calibration adjustments are applied

uniformly to all plans” in Section 13. (Objection #17)b. File name references and signing date updated, to be consistent with the names of the

new files being provided.2) 2020_PHW_Actuarial_Memo_20190624_Redacted

a. Updated the language in the paragraph labeled “Calibration adjustments are applieduniformly to all plans” in Section 13. (Objection #17)

b. File name references and signing date updated, to be consistent with the names of thenew files being provided.

3) 2020_PHW_State_Actuarial_Memo_20190624a. Updated induced utilization factors in Table B. (Objections #11, #24)b. Updated signing date for the new submission.

4) 2020_Indiv_PHW_PAAMExhibits_20190624a. Table 6

i. Added row for RA User fee. This amount was previously included with the HIF.(Objection #26)

b. Table 7i. Updated Benefit Richness Factor to be consistent with Table 10. (Objection #11)

c. Table 10i. Updated Benefit Richness Factors to aggregate to 1.00 and updated Pricing AV

Values. (Objection #11)5) 2020_PHW_Rate_Change_Request_Summary_20190624

a. Updated to reflect the average rate change and range of rate changes shown in Table 10of the PAAM. (Objection #18)

6) 2020_PHW_State_Appendices_20190624a. Appendix 1.3

i. Removed Base Rate, Product Adjustment, and Plan Factors. (Objection #17)b. Appendix 1.4

i. Replaced the Base Rate and Plan Factor with the Calibrated Plan Adjusted IndexRate. (Objection #17)

c. Appendix 8.1i. Expanded and re-ordered to be consistent with Appendix 20.1. (Objection #3)

d. Appendix 13.1i. Removed the Plan Rate Factor and Base Rate. (Objection #17)

e. Appendix 20.1i. Expanded to provide support for Appendix 8.1. (Objection #3)ii. Uniformly applied Individual Mandate morbidity adjustment across service

categories (Objection #5)f. Appendix 20.3

i. Normalized induced utilization factors to aggregate to 1.000 on PAAM Table 10.(Objections #11, #24)

g. Appendix 20.4i. Added current membership, and reflected the induced calibration factor.

(Objections #11, #24)ii. Removed Aggregate Plan Factor. (Objection #17)

7) 2020_PHW_State_Required_Cover_Letter_20190624a. Updated to reflect the average rate change and range of rate changes shown in Table 10

of the PAAM. (Objection #18)8) Rate/Rule tab in SERFF

a. Updated to reflect the average rate change and range of rate changes shown in Table 10of the PAAM. (Objection #18)

1. Please provide quantitative support for benefit differentials between plans showing the effect ofchanging benefits from 2019.

Please refer to the [Obj Exh 1] tab in the supporting excel workbook, Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb for quantitative support showing the effect of changingbenefits from 2019 to 2020. The exhibit includes only renewing plans.

2. Please explain how manual rate trends were selected considering they are significantly higher thanwere included in the prior filing.

The difference in manual rate trends from the 2019 filing to the 2020 filing is driven by the change inreimbursement basis for the starting manual base data. For the 2019 filing, base data was expressedon an estimated commercial market average reimbursement. For the 2020 filing, base data wasexpressed using a benchmark reimbursement level based on the Milliman Health Cost Guidelines.Note the much lower experience period manual allowed claims PMPM found in PAAM Table 2b for2020 compared to 2019. The starting assumption has no effect on the final rates, but affects thedisplay of the trends in Table 3b.

3. Please explain the differences between the adjustments applied in Appendix 8.1 and Appendix 20.1.Include the development of factors in Appendix 8.1 from values in Appendix 20.1, as appropriate.Also, provide information on the time period of the Base Data in Appendix 1, whether that reflectsnationwide or area adjusted values from the Milliman HCGs, whether the Base Data reflects billedcharge levels or discounted allowed, how much of the demographic shift is due to age differences inthe underlying population of the base data versus the projected (or if age reflects all of thedemographic adjustment), what degree of healthcare management level was assumed, and anyother pertinent information that would be helpful in understanding Appendices 8.1 and 20.1 andthe development of the manual projected index rate. Please provide quantitative support for eachof the factors.

The difference between the factors on Appendix 8.1 and 20.1 is that Appendix 8.1 includes a partialroll-up of some of the factors in Appendix 20.1. Objection Exhibit 3.1 and 3.2 have been provided asquantitative support for each factor in Appendix 8.1 and 20.1. Objection Exhibit 3.1 includes activeformulas in the “Impact” column to demonstrate the corresponding column in Objection Exhibit 3.2.

The base data, reflected as $365.14 PMPM in Appendix 8.1 and PAAM Table 2b, has the followingcharacteristics:

· Incurred dates for calendar year 2018;· Discounted allowed basis (provider reimbursement level), including nationwide average

pharmacy discounts off of AWP;· Nationwide commercial employer group population characteristics from the Health Cost

Guidelines;· Loosely managed utilization level.

The demographic adjustment made in Appendix 8.1 includes the impact of age and gender. PHWassumes its population is consistent with a moderately managed network.

4. Please provide support for the induced utilization in Table 3b.

Please refer to the [Obj Exh 4] tab in the supporting excel workbook, Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb for detail on each of the components that contributes tothe induced utilization values provided in the template. See the objection #12 response for adescription of the calculation (using the Milliman Health Cost Guidelines).

5. We see the PA required 6% morbidity adjustment for the individual mandate was applied inAppendix 20.1, however, it was not applied at the same level for all service categories. Why does theprescription drug category receive the largest impact of the adjustment?

We have revised our Appendix 20.1 to show uniform application of the 6% morbidity across all non-capitated service categories.

6. Was any private reinsurance included?

The rates include commercial stop loss premium, as shown in Appendix 12.2. PHW’s book ofbusiness is too small to credibly project reinsurance recoveries, and none are reflected in theprojected claims.

7. Please explain the grace period adjustment and why it is necessary.

Per the ACA, issuers are required to pay claims incurred during the first month of the grace periodfor members receiving APTCs who are subsequently terminated for non-payment of premium. Thegrace period adjustment accounts for the uncollectable premium from these members whose claimsPHW will still be liable for.

8. Please explain why the information for the PA single risk pool for 2017 was used instead of theinformation provided by the PA Department in the RATEE file for the 2018 plan year.

2017 PA single risk pool data was used in order to meet key dates in our rate development timelinedue to working with an external consultant in our rate development process. The RATEE data wasprovided by PID on 5/8/2019, less than two weeks before the filing deadline of 5/21/2019.

9. Considering a morbidity adjustment was made by analyzing the risk adjustment for the PApopulation compared to the data underlying the manual rate, please explain why you expect adifferent relative morbidity in 2020.

Relative morbidity for the PHW population relative to the overall PA Individual market was updatedfrom ''''''''''' '''' '''''' '''''''''' ''''''''' '''' ''''''''''' '''' ''''''' ''''''''' ''''''''''. As part of our annual rate development,we review the emerging relative morbidity data from recent Ambetter first- and second-year statesto confirm the assumptions being used are consistent with recent experience. Based on this review,''''''' '''''''''''''''''' ''''''''' ''''''''''' '''''''''''' ''''''''''''''' ''''''''''''''''''' ''''''''''' '''''''''' '''''' '''''''' ''''''''''''''''' '''' '''''''''''''''''''''''''' '''''''''''' '''' '''''''''''''''''' '''''''''''''

10. Please provide quantitative support for the AV and cost sharing factors in Appendix 20.3 and pleaseexplain why the AV and cost sharing factors for some of the silver plans (i.e., plans 14 and 15) arecomparable to the gold amounts.

Please refer to the [Obj Exh 10, 12] tab in the supporting excel workbook, Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb for quantitative support of plan relativities for all plans,

particularly the specified silver plans (i.e., plans 14 and 15). The relativities are informed by the datasupporting manual rating, including AV Calibration, which adjusts for historical national experience.

Please note that the two plans in question (Balanced Care 14 and 15) are richer silver designs whichfurther get pushed up closer to the Gold level due to a uniform 20% load on silver plans to accountfor the non-funding of CSRs (note in the exhibit this is shown as a 17% decrease in Gold/Bronze ratesin order to preserve the 1.000 basis of the Balanced Care 5 design). The Gold plans in Pennsylvaniado not receive any load.

11. The benefit richness included in Table 10 must be normalized to an average of 1.0000. Pleaseresubmit to correct.

We have submitted an updated version of PAAM Table 10 where the aggregate benefit richness hasbeen normalized to a weighted average of 1.0000.

12. The gold/bronze induced demand relativities are around 18%, which is significantly higher than the8% ratio included in the HHS risk adjustment model. Please provide significant narrative andquantitative support for these induced demand factors, and why they vary within metal level.

Please refer to the [Obj Exh 10, 12] tab in the supporting excel workbook, Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb for quantitative support of the induced utilization.

The induced utilization factors by plan are developed using the Milliman Managed Care RatingModel (MCRM). The MCRM is an automated version of the Health Cost Guidelines (HCGs) andRating Structures and reflects significant research including the combined experience, data, andactuarial judgment of many sources. The Health Cost Guidelines show more sensitivity in inducedutilization (gold vs bronze) than the HHS Induced Utilization factors. We believe the HCGs to bemore appropriate for our modeling purposes because they vary by plan design structure, and not bymetal level. This captures the cost sharing structure better, and generates more reasonable results.For example, changes in copays on some less elective services such as IP visits can have a significantimpact on the AV of the design but not on the induced utilization. On the other hand, changes incopays for Office Visits (generally very elective) can have a significant impact on the inducedutilization. The HCGs are able to capture this, whereas the HHS factors are an approximation over allplans within a metal tier. HHS has further stated that they are going to revisit these inducedutilization factors.

As shown on the [Obj Exh 10, 12] tab there are two components to our modeled induced utilization:global adjustments to services subject to the deductible and service line adjustments to servicessubject only to copays and/or coinsurance. The global induced utilization adjustment for servicessubject to the deductible reflects demand for additional or fewer services due to the globalcharacteristics of the plan design such as overall coinsurance, deductible, and MOOP. The serviceline induced utilization reflections additional or fewer services due to the copay associated with theservice, such as a copay on a PCP office visit.

13. Please provide quantitative support for the 4.7% for the non-EHB adult vision and dental.

Please refer to the [Obj Exh 13] tab in the supporting excel workbook, Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb.

14. Document your calculation of the 0.27% state income tax factor (and the PMPM amount) with allthe factors and assumptions used such as income tax rate.

The 0.27% state income tax factor was calculated as follows, assuming 2.56% pre-tax profit and a taxrate of 10.59% of pre-tax profit:

(0.1059)(2.56%) = 0.27%

The PMPM amount of $1.60 was calculated by applying this percentage to average premium of$590.41:

(0.0027)($590.41) = $1.60

15. Please provide quantitative support for the 2.42% ($14.27 PMPM amount) health insurer fee. Pleaseinclude all assumptions and data used such as market share. PHW’s support Appendix 12.2 showsthe PMPM to be $14.09.

Regarding the difference in PMPM values between PAAM Table 6 ($14.27) and Appendix 12.2($14.09), the PAAM Table 6 amount also included the risk adjustment user fee of $0.18 PMPM. Peritem #26 in this objection letter, the risk adjustment user fee has been moved to its own new row inPAAM Table 6. With this update, both PAAM Table 6 and Appendix 12.2 reflect the same PMPMvalue for the HIF, $14.09.

We used an assumption of 2.63% of total revenue for the HIF in rate development in all Ambetterstates. The 2.42% in PAAM Table 6 (now 2.39% due to the relocation of the RA user fee) is becausethat is expressed as a percentage of premium, while the 2.63% is a percentage of total revenue (i.e.,premium minus RA payable).

Please refer to the [Obj Exh 15] tab in the supporting excel workbook, Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb for quantitative support of the 2.63% used nationally. Thetax rates shown in the table are averages of Ambetter states.

16. Please provide the source of information contained in Table 8 and 9, components of rate change.Please explain why row H is not equivalent to row A.

All yellow-shaded 2019 values in Tables 8 and 9 are populated from PHW’s prior approved 2019 PAActuarial Memorandum Rate Exhibits. There was no change in miscellaneous items for 2020. The2020 capitation amount in Table 9 was determined as the PMPM for capitated services and ties toAppendix 20.1. All other values in Table 8 and Table 9 are hard-coded formulas.

Please note that Table 8 Line H differs from Table 8 Line A as a result of differences in the 2019values. The 2019 Pricing AV in Table 9 is used in the calculation of several Line E items. In thecolumns for 2019, consistent with what was shown in last year’s approved template, the Pricing AVwas calculated as a straight average for 2019 plan-specific factors. This methodology was usedbecause there was no membership available due to 2019 being a new filing. This differs from themethodology used to calculate the Plan Adjusted Index Rate in Line A, which is aggregated based onthe current membership distribution by plan.

17. In Appendix 20.4 and on Page 23 of the Part III Actuarial Memorandum, there is an additional steptaken that is not allowed in the rating rules, dividing the Calibrated PAIR by the average plan factor.This is not one of the allowable factors. Please correct this.

We have revised our Appendix 20.4 and the Part III Actuarial Memorandum to remove the step ofdividing by the average plan factor. Note that the subsequent base rate was multiplied by the planfactor to develop final rates. This was done for illustrative purposes and did not affect thedevelopment of the consumer adjusted rates. Appendix 1.3, Appendix 1.4, and Appendix 13.1 havealso been revised to remove this additional step for consistency.

18. The Rate Change and the Range of rate change – Table 10 of PAAM shows the average rate changeas -1.4% and the range is -5.03% to 0.39%. These do not match the Cover letter, Rate ChangeSummary and the Rate/Rule TAB in SERFF. Please correct these.

We have updated the Cover Letter, Rate Change Summary, and Rate/Rule Tab in SERFF to reflect theaverage rate change (-1.36%) and range (-5.09% to 0.40%) shown in Table 10 of the PAAM.

19. URRT versus PAAM Exhibit Tables – Please explain and correct the discrepancy in the ProjectedIndex between URRT, WKST 2, Section II ($538.90) and URRT, WKST 1 & Table 5 of PAAM ($537.19).

The $538.90 in URRT Worksheet 2 Section IV (we are assuming the reference to Section II in thequestion was a typo) represents all projected allowed claims PMPM, including EHB and non-EHBclaims. The $537.19 in URRT Worksheet 1 and PAAM Table 5 includes only projected EHB AllowedClaims. Since the two values represent different claims per the definitions in the URRT instructionsand PA filing guidance, no correction is needed.

20. Paid-to-Allowed Ratio - Please explain why you believe that the method you have used in thecalculation of the Paid-to-Allowed Ratio is more reasonable than the PID recommended calculationas per the formula in cell C28 of Table 5 of PAAM. The formula is auto-calculated from entries madefor Plan Pricing AVs, Non-Funding CSR adjustment and Total Covered Mapped Lives as of 2/1/2019.The issuer may over-write the formula and use projected enrollment, if appropriate.

The original formula for the Paid-to-Allowed Ratio in Cell 28 of Table 5 links to Cell K15 of Table 10.This Pricing AV value is weighted by current membership. We have overwritten the formula to enterthe aggregate Paid-to-Allowed ratio used in our pricing, which is weighted on projected enrollment.We believe this is a more reasonable approach because the paid to allowed ratio reflects projectionsfor all plans, not just renewing plans.

21. Federal Tax Factor – Please provide the calculation of the Federal Tax factor of 0.54% in Table 6 ofPAAM. Please note that the tax rate is now 21% and applied to 1.75% Profit results in a factor of0.36%

1.75% represents the after-tax profit. The federal income tax factor of 0.54% is calculated byapplying the 21% tax rate to pre-tax profit of 2.56%, as follows:

(0.21)(2.56%) = 0.54%

22. Please provide an exhibit that shows, by HIOS Plan ID, summary benefit and cost sharing changes for2020 relative to the 2019 design for all plans to be offered in 2020. Include Pricing AV columns for

2019 and 2020. Please show the approved 2019 Pricing AVs for all plans in the 2019 column and theproposed 2020 Pricing AVs in the 2020 column.

Please refer to the [Obj Exh 22] tab in the supporting excel workbook, Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb The Pricing AVs in the table are from PAAM Table 10column K. Cost sharing changes are highlighted in yellow – the 2020 value appears first, and the2019 value appear second, in parentheses.

23. Risk Adjustment Data Validation process (RADV) -a) Please describe any adjustments or considerations made due to the Risk Adjustment Data

Validation process (RADV).

As a new issuer in 2019, PHW did not participate in the RADV process for 2017 data, and noadjustments were made in our rate development.

b) As you know CMS is performing a risk adjustment validation starting with 2017 riskadjustment data. We are considering allowing an estimate of the impact of risk adjustmentmodifications in rate filings as an adjustment to the projected risk adjustment. Beforeimplementation, we are soliciting feedback from our issuers on the pros and cons of theinclusion of this adjustment. If allowed, all issuers would be required to submit an estimate.The estimate may be $0. Please provide any feedback that you would like us to consider.

As a new issuer in 2019 in Pennsylvania with no experience or RADV results, we do not haveany feedback on including an adjustment in 2020 pricing for this market.

24. Induced Utilization Exhibit – Please provide Exhibit B: Induced Utilization Exhibit as per PA RateFiling Guidance, Page 15.

Exhibit B is provided in the PA State Actuarial Memorandum, and again as Appendix 20.3. Pleasenote that both the PA State Actuarial Memorandum and Appendices have been resubmitted tocapture the adjustments needed to normalize induced utilization to 1.000, per Objection #11.

a) Please confirm that the ratio in Column (9) represents the pure induced utilization for eachplan.

We confirm that the ratio in Column (9) represents the pure induced utilization for eachplan.

b) Please show quantitatively, including an Excel spreadsheet with formulas, the derivation ofthe AV and cost sharing factors for each plan. Please note that it is assumed that the AV andcost sharing factor includes the average tobacco factor.

The derivation of the AV and cost sharing factors for each plan is shown in the updatedversion of Appendix 20.4.

c) Please provide any additional justification for induced utilization assumptions in theCompany’s pricing.

The induced utilization build-up may be found across several appendices.

Induced utilization is calculated as the Normalized AV and Cost Sharing factor (developed inAppendix 20.4), divided by the product of the Paid-to-Allowed factor (developed inAppendix 20.3) and the inverse of the average tobacco factor (developed in Appendix 13.4).

d) Please confirm that each plan’s induced utilization factor was normalized by an aggregatefactor, and that the resulting sum product (against 2/1/2019 membership or the projectedmembership distribution) produces a factor of 1.

We confirm that each plan’s induced utilization factor was normalized by an aggregatefactor, resulting in an aggregate induced utilization factor of 1.000.

e) Please quantitatively demonstrate the calculation of the induced calibration factor.

The calculation of the normalization factor used to produce an aggregate induced utilizationvalue of 1.000 is shown in Appendix 20.4.

f) Please quantitatively show and provide a detailed description as to how the induceddemand factor shown in Table 7 relates to the induced utilization factors calculated in the“Induced Utilization Exhibit” shown in the Actuarial Memorandum.

The 1.000 Benefit Richness factor on Table 7 is equal to the aggregate Benefit Richnessfactor calculated in Table 10. The plan level Benefit Richness values tie exactly to the valuesshown in Exhibit B in the State Actuarial Memorandum and also Appendix 20.3.

25. Please show the development of the average commission as shown in Table 6. Additionally, thecurrent and 2020 broker agreements should be included and used to develop the percent shown inTable 6 as well as the associated PMPM cost.

Average commission is $2.51 PMPM. '''''''' '''' '''''''''''' ''''' '''''''''''''''''''''' '''' '''''''''''' '''''''''''' ''''''''''''''''''''''''''''''''''''' '''' '''''''''''' ''''''''' ''''''''''''' ''''''''''''''''''''' '''''''' '''''''''''' '''''''''''''''''''''' ''''' ''''''''''''' '''''''''''''

'''''''''''''''''''''''''''' '' '''''''''''

The $3.26 PMPM shown in PAAM Table 6 and Appendix 12.2 also includes $0.75 PMPM sales/callcenter overhead.

A sample producer agreement was included in the HHS Actuarial Memo as Appendix 20.2. Thisagreement has not changed from 2019 to 2020.

26. We have repurposed row 54 to capture RA User Fees. Please provide the RA User Fee percentageand PMPM amount in cells C54 and D54, respectively.

A new version of PAAM Table 6 has been submitted reflecting this update.

27. Please confirm that you have tested to ensure that the rates in Table 11 of the ActuarialMemorandum Exhibits, PA Plan Design Summary and Rate Tables, Federal Rates Template and thebinder are identical.

Yes, we reviewed the rates to ensure consistency across these files prior to submitting our filing.

28. For the expanded Bronze plans, please demonstrate that the copay is less than or equal to 50%coinsurance for that category.

PHW did not originally set the generic Rx copay with the intention that it would be less than or equalto 50% coinsurance for that category. Based on supporting documentation provided by PID, ourcurrent understanding is that CMS suggests a 50% cost-sharing threshold would be reasonable toconstitute coverage of a major service before the deductible for the purposes of meeting ExpandedBronze requirements.

The Essential Care 1 plan design does not satisfy the Expanded Bronze requirements including the50% threshold. However, the metal AV of this plan design is 60.32%, which is within the de minimisrange for regular Bronze plans. Therefore, we have updated the Essential Care 1 and Essential Care1 + Vision + Adult Dental plans to indicate a metal tier of Bronze instead of Expanded Bronze in ourAV screenshots. The binder and form filings will also be updated to reflect this change.

The Essential Care 2 HSA and Essential Care 4 HSA plan designs both satisfy the requirements to beconsidered Expanded Bronze plans because both are qualified high deductible health plans. TheEssential Care 10 plan design also satisfies the Expanded Bronze requirements due to the PCP visitcost-sharing. We have not made any updates for these plans.

Objection Exhibit 1Pennsylvania Health & Wellness, Inc.

Paid PMPM Impact from Plan Design Changes

Estimated Paid PMPM Paid Impact fromChange in Benefits

Line Item 2020 Plan Designs 2019 Plan Designs %Balanced Care 5 (2020) - Standard Silver On Exchange Plan 375.01 374.73 0.1%Balanced Care 5 (2020) - 73% AV Level Silver Plan 387.42 390.48 -0.8%Balanced Care 5 (2020) - 87% AV Level Silver Plan 509.48 509.48 0.0%Balanced Care 5 (2020) - 94% AV Level Silver Plan 570.65 570.65 0.0%Balanced Care 11 (2020) - Standard Silver On Exchange Plan 375.00 376.27 -0.3%Balanced Care 11 (2020) - 73% AV Level Silver Plan 389.63 393.27 -0.9%Balanced Care 11 (2020) - 87% AV Level Silver Plan 483.67 493.56 -2.0%Balanced Care 11 (2020) - 94% AV Level Silver Plan 566.44 567.47 -0.2%Essential Care 1 (2020) - Standard Bronze On Exchange Plan 332.28 337.16 -1.5%

Objection Exhibit 3.1Pennsylvania Health & Wellness, Inc.

Manual Rate BuildupClaims PMPM

Line Item Total Impact NotesBase Data $365.14

* Cost trend and provider reimbursement 388.14 1.063* Rating region - Cost 429.33 1.106 Previously combined into one Rating region line* Rating region - Util 483.02 1.125 Previously combined into one Rating region line* Utilization trend 505.43 1.046* Calibration based on relevant QHP experience 468.88 0.928* Prior Auth. / DUR / Disease Management 461.87 0.985 Previously included with expected utilization management savings* Induced Utilization 437.70 0.948 Previously included with benefit plan designs* Expected morbidity 483.14 1.104* Expected demographics 583.37 1.207* Expected utilization management savings 543.17 0.931* Benefit plan designs 535.04 0.985* Grace Period 537.19 1.004Manual EHB Allowed Claims PMPM $537.19

Objection Exhibit 3.2Pennsylvania Health & Wellness, Inc.


Cost Trend Adj Util Trend Adj Induced Util Trend Morbidity Adjustments Demo Adjustments Network Adjustments Benefits Adjustments Other Adjustments

StartingManual Data

Cost Adj(App 8.1)

Rating Region -Cost

(App 8.1)Total Cost Adj

(App 20.1)

Rating Region -Util

(App 8.1)

UtilizationTrend Adj(App 8.1)

Calibration Adj(App 8.1)

Prior Auth. / DUR / DiseaseManagement Adj

(App 8.1)Total Util Adj

(App 20.1)

Induced UtilAdjustments

(App 8.1)After Initial

Adj

Impact ofTrend

AdjustmentClaimsMargin


Cost


Util

Change inMorbidity - UtilIndiv Mandate

AfterMorbidity

Impact ofMorbidity

Adjustments(App 8.1)


Cost


UtilAfter

Demographics

Impact ofDemographicAdjustments

(App 8.1)

Change inNetwork -

Cost

Change inNetwork -

UtilAfter

Network

Impact ofNetwork


Change inBenefits -

Cost

Change inBenefits -

UtilAfter BenefitAdjustments

Impact ofBenefit


GracePeriod

Change inOther - Util After Other

Impact ofOther


Inpatient Hospital 79.35 1.145 1.088 1.246 1.196 1.051 0.928 1.000 1.165 0.949 109.38 1.378 1.000 1.000 1.047 1.060 121.40 1.110 1.013 1.178 144.92 1.194 1.000 0.903 130.82 0.903 1.000 0.996 130.26 0.996 1.004 1.000 130.79 1.004Outpatient Hospital 76.81 0.993 1.177 1.168 1.073 1.051 0.928 1.000 1.045 0.945 88.66 1.154 1.000 1.000 1.047 1.060 98.40 1.110 1.040 1.203 123.14 1.251 1.000 0.889 109.50 0.889 1.000 1.003 109.87 1.003 1.004 1.000 110.31 1.004Professional 100.41 1.081 1.094 1.182 1.120 1.049 0.927 1.000 1.089 0.945 122.16 1.217 1.000 1.000 1.047 1.060 135.58 1.110 1.005 1.129 153.95 1.135 1.000 0.925 142.47 0.925 1.000 0.961 136.85 0.961 1.004 1.000 137.40 1.004Other Medical 9.76 0.833 1.180 0.983 1.034 1.051 0.928 1.000 1.007 0.891 8.61 0.882 1.000 1.000 1.047 1.060 9.56 1.110 0.982 1.186 11.13 1.164 1.000 0.912 10.15 0.912 1.000 0.771 7.83 0.771 1.004 1.000 7.86 1.004Capitation 1.73 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.000 1.73 1.000 1.000 1.000 1.000 1.000 1.73 1.000 1.000 1.000 1.73 1.000 1.000 1.000 1.73 1.000 1.000 1.000 1.73 1.000 1.000 1.000 1.73 1.000Prescription Drug 97.07 1.057 1.078 1.140 1.120 1.037 0.928 0.941 1.014 0.955 107.15 1.104 1.000 1.000 1.025 1.060 116.46 1.087 1.004 1.270 148.50 1.275 1.000 1.000 148.50 1.000 1.000 1.000 148.50 1.000 1.004 1.000 149.10 1.004Total 365.14 1.063 1.106 1.125 1.046 0.928 0.985 0.948 437.70 1.199 483.14 1.104 583.37 1.207 543.17 0.931 535.04 0.985 537.19 1.004


Development of Induced Utilization Factors by Service Category

Service Category

Induced Utilization- Services Subject

to Deductible

Induced Utilization -Services Subject to

Copays/Coinsuranceonly

Total InducedUtilization

Inpatient Hospital 0.95 1.00 0.95Outpatient Hospital 0.95 1.00 0.95Professional 0.97 0.98 0.95Other Medical 0.95 0.94 0.89Capitation 1.00 n/a 1.00Prescription Drug 0.96 1.00 0.96

Objection Exhibit 10, 12Pennsylvania Health & Wellness, Inc.

Development of AV Pricing and Rating Factor (AV & Cost Sharing) Relativities

Secure Care 5 Balanced Care 5 Balanced Care 11 Balanced Care 12 Balanced Care 14 Balanced Care 15 Essential Care 1 Essential Care 2 Essential Care 4 Essential Care 10

Member Months 1,438 9,509 33,919 23,577 3,699 48 16,931 12 5,972 16,924

Single Risk Pool Claims PMPMAllowed PMPM (Single Risk Pool) $538.90Paid PMPM (Single Risk Pool) $442.23

Induced Utilization (Health Cost Guidelines)Allowed PMPM (Single Risk Pool) $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90Induced Utilization - Svcs. Subj only to Copays/Coins 1.004 0.992 0.983 0.978 0.955 0.986 0.981 0.981 0.996 0.973Induced Utilization - Services Subject to Deductible 1.007 0.923 0.937 0.941 0.968 0.962 0.899 0.933 0.928 0.910Allowed PMPM (Plan) $544.62 $493.49 $496.70 $495.49 $498.18 $511.08 $475.36 $493.13 $497.73 $477.21

Actuarial Value (Claims Simulation)Allowed PMPM (Plan) $544.62 $493.49 $496.70 $495.49 $498.18 $511.08 $475.36 $493.13 $497.73 $477.21Deductible -6.9% -23.5% -20.2% -21.2% 0.0% -13.0% -34.4% -33.5% -29.8% -26.4%Copays/Coinsurance -17.9% -6.4% -26.8% -27.2% -44.4% -29.8% -1.5% 0.0% -20.5% -32.8%MOOP +8.2% +2.1% +19.3% +19.9% +20.9% +17.3% +0.5% 0.0% +17.4% +26.7%Paid PMPM $454.55 $356.47 $359.15 $354.40 $381.38 $380.58 $306.80 $328.06 $334.27 $321.91Preliminary 2020 Plan Factor 1.275 1.000 1.008 0.994 1.070 1.068 0.861 0.920 0.938 0.903

Stabilization (Prior Rating Factors)Preliminary 2020 Plan Factor 1.275 1.000 1.008 0.994 1.070 1.068 0.861 0.920 0.938 0.9032019 Plan Factor, CSR Funded (1) 1.346 1.000 0.968 0.955 1.070 1.068 0.945 1.011 1.030 0.9922019 Factor Blend % 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%2020 Plan Factor, CSR Funded 1.311 1.000 0.988 0.975 1.070 1.068 0.903 0.965 0.984 0.947

CSR Non-Funding2020 Plan Factor, CSR Funded 1.311 1.000 0.988 0.975 1.070 1.068 0.903 0.965 0.984 0.9472020 CSR non-Funding Rate Load 0.833 1.000 1.000 1.000 1.000 1.000 0.833 0.833 0.833 0.833Final 2020 Plan Factor 1.092 1.000 0.988 0.975 1.070 1.068 0.752 0.805 0.820 0.790

AV and Cost Sharing FactorAV and Cost Sharing Factor 0.979 0.896 0.885 0.874 0.959 0.957 0.674 0.721 0.735 0.708

Induced Utilization Component 1.110 1.006 1.012 1.010 1.015 1.041 0.969 1.005 1.014 0.972AV Component 0.882 0.891 0.875 0.865 0.944 0.919 0.696 0.718 0.724 0.728

(1) New plans use 2019 plan factors from the following plans as follows, adjusted with their 2020 CSM relativity:- Secure Care 5 uses Secure Care 1- Balanced Care 12 uses Balanced Care 11- Balanced Care 14 and 15 use Balanced Care 5- Essential Care 2, 4, and 10 use Essential Care 1

Page 1 of 2

Milliman7/12/2019 12:08 PM\\seath-filer.milliman.com\Projects\jnowakowski\CEN\CEN42 - Rate Filings\2020 HIX\PA - 81\Data\20190628 Submitted Response to 20190618 Objections\Objection Exhibits PA_Obj 2_86199_Rate_061819_Due_062519\[Obj Exh 10, 12]

(a) Base Rate $369.74(b) Product Adjustment $17.36(c) Non-EHB Benefits Adjustment = (b) / (a) 4.7%


Non-EHB Adjustment

Objection Exhibit 15Pennsylvania Health & Wellness, Inc.Development of Health Insurer Fee

2018 HIF Fee 14,300,000,000% of Premium Growth 16.40%2020 HIF Fee 16,645,200,000

2019 Projected Market Premium 829,500,000,000

HIF % 2.01%

Income Tax Rate (State/Federal) 22.23%Income Tax Gross-up 0.57%Grossed-up Fee % (Income tax only) 2.58%

Premium Tax Rate 1.75%Gross-up for Premium Tax 0.05%

Total Grossed-up HIF % (Income & Premium Tax) 2.63%


Summary of Cost Sharing and Pricing AV Changes

Rx Member Cost-Sharing

Plan Design Plan ID Plan Type Medical DeductibleMember

CoinsuranceRx

DeductibleOOP Max PCP Visit

SpecialistVisit

GenericPreferred

BrandNon-Preferred

BrandSpecialty

Includes adultvision

coverage?

Includes adultdental

coverage?

2019 PricingAV

2020 PricingAV

Ambetter Balanced Care 5 86199PA0010005 HMO $7350 INT 0% INT $7,350 $40 NSD $80 NSD $20 NSD $60 NSD $0 SD (D&C) $0 SD N N 0.743 0.741Ambetter Balanced Care 11 86199PA0010004 HMO $6000 INT 40% INT $8,100 ($7,900) $30 NSD $60 NSD $20 NSD $50 NSD 50% SD (D&C) 50% SD (40% SD) N N 0.707 0.727Ambetter Essential Care 1 86199PA0010002 HMO $8150 INT ($7900 INT)0% INT $8,150 ($7,900) $0 SD (D&C) $0 SD (D&C) $20 NSD $0 SD (D&C) $0 SD (D&C) $0 SD N N 0.713 0.695

D&C – Deductible and CoinsuranceINT – Integrated Medical and Rx DeductibleNSD – Not subject to deductibleSD – Subject to deductibleRx Copay – Generic / Preferred Brand / Non-Preferred Brand / Specialty

Milliman

1. Follow up to question 10 and 12: Please explain why factors provided in worksheet “ObjectionExhibits PA_Obj 2 86199_Rate_061819_Due_062519.xlsb” on tab “Obj Exh 10, 12” do not matchvalues in Table 10 or Appendix 20.3 and 20.4. The AV and Cost Sharing factors provided in tab “ObjExh 10, 12” do match values in the URRT worksheet 2. For example, for plan Ambetter BalancedCare 11, Table 10 shows an AV of 0.727, and an Induced Utilization factor (Benefit Richness) of1.014, and the 1.20 factor for non-funding of CSR. Multiplying the AV value of .727 by 1.2 results inan AV adjusted for nonfunding of CSR of .8724. Appendix 20.3 shows an induced utilization factor of1.014, an AV and Cost Sharing factor of .8823, so dividing would get an AV of 0.8698. Then tab “ObjExh 10, 12” in the response worksheet shows an AV of .8747 and an induced utilization factor of1.0122. Please provide qualitative and quantitative support for the induced utilization factors in theresponse worksheet, tab “Obj Exh 10, 12” rather than hard coded values in row 41, “InducedUtilization Component”. In particular, it looks like these values equal the 2 factors from rows 16 and17 multiplied by 1.0982. Why?

Please refer to the updated version of the [Obj Exh 10, 12] tab in CELT-131936143 Response to20190705 Objections - Exhibits.xlsb for quantitative support showing the development of theinduced utilization factors.

Using the plan Ambetter Balanced Care 11 as an example, the AV & Cost Sharing Design of the planin row 41 (0.885) can be broken up into three separate components of the tobacco calibration factor(0.994), the induced utilization factor (1.018), and the AV Component, or Paid to Allowed ratio(0.875). The induced utilization and AV component values are provided with formulas in our Excelresponse and tie to the values provided in Appendix 20.4.

The induced utilization factor is calculated as the Plan Allowed PMPM from row 19 ($496.70),divided by the product of the weighted average Plan Allowed PMPM (calculated as $490.73) and thetobacco calibration factor (0.994). The ratio of the Single Risk Pool Allowed PMPM ($538.90) to theweighted average Plan Allowed PMPM ($490.73) is equal to the 1.0982 quoted in the objection.

These raw values are then normalized in Appendix 20.4 so that the final induced utilization factoraggregates to 1.000 on Table 10. The induced calibration factor (1.003) is netted out of the Raw AV& Cost-Sharing Factor, resulting in a normalized AV & Cost-Sharing factor (0.882) and normalizedinduced utilization factor (1.014), which tie to Appendix 20.3. This normalized induced utilizationfactor ties to Table 10, and the product of the Pricing AV (0.727), Benefit Richness (1.014), and Non-Funding of CSR Adjustment (1.200) from Table 10 equal the original AV & Cost-Sharing Design of theplan (0.885) shown on [Objection Exhibit 10, 12].

2. Follow up from question 13: Please provide the qualitative and quantitative support for thedevelopment of the $17.36 PMPM for non-EHB adult vision and dental The Revised PAAM exhibits isnot using the template sent by PID on June 18, 2019. Table 6 does not show the Risk AdjustmentUser Fee in Row 54. Please upload the corrected version.

Please refer to the updated version of the [Obj Exh 13] tab in CELT-131936143 Response to20190705 Objections - Exhibits.xlsb for additional quantitative support for the development of the$17.36 PMPM for non-EHB adult vision and dental. Both adult vision and adult dental are capitatedservices. Paid and Premium PMPMs are determined by the capitation agreements.

For the second part of this question (regarding PAAM Table 6), we confirmed in a phone call withPID on 7/9/2019 that the revised PAAM exhibit file submitted with our previous objection responsesdoes include the RA user fee in Table 6 Row 54 as requested, and no correction is necessary.

3. Follow up to question 22: Why is the 2020 Pricing AV increasing for plan Ambetter Balanced Care 11compared to 2019 when benefits seem to be less rich, as seen on tab “Obj Exh 22” on worksheet“Objection Exhibits PA_Obj2_86199_Rate_061819_Due_062519.xlsb”?

The increase in pricing AV for Balanced Care 11 is due to a change in our methodology fordeveloping pricing AVs for 2020. For 2019, pricing AVs were developed using the Milliman MCRM(Managed Care Rating Model). For 2020, pricing AVs were developed using a 50/50 blend of theMCRM and Claims Simulation Model. We chose to use a blend in order to limit the impact of thechange in methodology.

The federal AV calculator lends directional support for the change to Balanced Care 11 as well, asthe metal AV for this plan increased from 68.32% in 2019 to 69.46% in 2020.

4. Question 18: Please upload the revised cover letter on to SERFF.

The revised cover letter has been uploaded.

5. Question 28 of June 18, 2019 letter – Your response does not demonstrate that the projectedAverage cost is greater than 50% of the cost sharing as per my email of June 21, 2019. For theEssential Care 10 Expanded Bronze plans, is there any major benefit category to which deductible innot applied. If there is, please demonstrate quantitatively that the proposed cost sharing (copay orcoinsurance) for those major categories is less than or equal to 50% of the Projected Average cost toprovide the service in your rating area. Please follow the example shown in my email.

We respectfully request that you reconsider this objection. In our review of both the 2018 Notice ofBenefit & Payment Parameters (NBPP) and the email response to you from CMS, the requirement isthat the issuer must pay for at least one major service before the deductible, within reasonable costsharing. This is outlined on the bottom of page 303 of the NBPP (attached for reference). CMS goeson to state on page 305-306 that any cost sharing rate that requires the enrollee to pay for morethan 50 percent of the coinsurance (or the equivalent copay rate) could be considered anunreasonable cost-sharing rate for the major service. The reasonable cost sharing applies to themajor service that the issuer chooses to cover before the deductible. It does not apply to all majorservices- as the requirement outlined in 45 CFR 156.140(c) is that only one major service needs to becovered before deductible. We have highlighted portions of the NBPP which speak to this topic.

On the Essential Care 10 Expanded Bronze Plan, the PCP visit cost sharing is the major service that iscovered prior to deductible with a 50% coinsurance, which would meet the definition laid out byCMS. Therefore, EC10 meets the requirements laid out by CMS for an Expanded Bronze Plan.

Objection Exhibit 10, 12Pennsylvania Health & Wellness, Inc.

Development of AV Pricing and Rating Factor (AV & Cost Sharing) Relativities

Secure Care 5 Balanced Care 5 Balanced Care 11 Balanced Care 12 Balanced Care 14 Balanced Care 15 Essential Care 1 Essential Care 2 Essential Care 4 Essential Care 10

Projected Member Months 1,438 9,509 33,919 23,577 3,699 48 16,931 12 5,972 16,924Current Membership 24 192 990 - 17 - 646 - - -

Single Risk Pool Claims PMPMAllowed PMPM (Single Risk Pool) $538.90Paid PMPM (Single Risk Pool) $442.23

Induced Utilization (Health Cost Guidelines)Allowed PMPM (Single Risk Pool) $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90 $538.90Induced Utilization - Svcs. Subj only to Copays/Coins 1.004 0.992 0.983 0.978 0.955 0.986 0.981 0.981 0.996 0.973Induced Utilization - Services Subject to Deductible 1.007 0.923 0.937 0.941 0.968 0.962 0.899 0.933 0.928 0.910Allowed PMPM (Plan) $544.62 $493.49 $496.70 $495.49 $498.18 $511.08 $475.36 $493.13 $497.73 $477.21

Actuarial Value (Claims Simulation)Allowed PMPM (Plan) $544.62 $493.49 $496.70 $495.49 $498.18 $511.08 $475.36 $493.13 $497.73 $477.21Deductible -6.9% -23.5% -20.2% -21.2% 0.0% -13.0% -34.4% -33.5% -29.8% -26.4%Copays/Coinsurance -17.9% -6.4% -26.8% -27.2% -44.4% -29.8% -1.5% 0.0% -20.5% -32.8%MOOP +8.2% +2.1% +19.3% +19.9% +20.9% +17.3% +0.5% 0.0% +17.4% +26.7%Paid PMPM $454.55 $356.47 $359.15 $354.40 $381.38 $380.58 $306.80 $328.06 $334.27 $321.91Preliminary 2020 Plan Factor 1.275 1.000 1.008 0.994 1.070 1.068 0.861 0.920 0.938 0.903

Stabilization (Prior Rating Factors)Preliminary 2020 Plan Factor 1.275 1.000 1.008 0.994 1.070 1.068 0.861 0.920 0.938 0.9032019 Plan Factor, CSR Funded (1) 1.346 1.000 0.968 0.955 1.070 1.068 0.945 1.011 1.030 0.9922019 Factor Blend % 50% 50% 50% 50% 50% 50% 50% 50% 50% 50%2020 Plan Factor, CSR Funded 1.311 1.000 0.988 0.975 1.070 1.068 0.903 0.965 0.984 0.947

CSR Non-Funding2020 Plan Factor, CSR Funded 1.311 1.000 0.988 0.975 1.070 1.068 0.903 0.965 0.984 0.9472020 CSR non-Funding Rate Load 0.833 1.000 1.000 1.000 1.000 1.000 0.833 0.833 0.833 0.833Final 2020 Plan Factor 1.092 1.000 0.988 0.975 1.070 1.068 0.752 0.805 0.820 0.790

AV and Cost Sharing FactorRaw AV and Cost Sharing Factor 0.979 0.896 0.885 0.874 0.959 0.957 0.674 0.721 0.735 0.708

Tobacco Calibration Component 0.994 0.994 0.994 0.994 0.994 0.994 0.994 0.994 0.994 0.994Induced Utilization Component 1.116 1.011 1.018 1.015 1.021 1.047 0.974 1.011 1.020 0.978AV Component 0.882 0.891 0.875 0.865 0.944 0.919 0.696 0.718 0.724 0.728

Induced Calibration Factor 1.003 1.003 1.003 1.003 1.003 1.003 1.003 1.003 1.003 1.003

AV and Cost Sharing Factor 0.975 0.893 0.882 0.871 0.956 0.954 0.672 0.719 0.732 0.705Tobacco Calibration Component 0.994 0.994 0.994 0.994 0.994 0.994 0.994 0.994 0.994 0.994Normalized Induced Utilization Component 1.112 1.008 1.014 1.012 1.017 1.044 0.971 1.007 1.017 0.975AV Component 0.882 0.891 0.875 0.865 0.944 0.919 0.696 0.718 0.724 0.728

(1) New plans use 2019 plan factors from the following plans as follows, adjusted with their 2020 CSM relativity:- Secure Care 5 uses Secure Care 1- Balanced Care 12 uses Balanced Care 11- Balanced Care 14 and 15 use Balanced Care 5- Essential Care 2, 4, and 10 use Essential Care 1

Objection Exhibit 13Pennsylvania Health & Wellness, Inc.Non-EHB Projected Cost Summary

Non-EHB Benefit Paid Claims PMPM Premium PMPMAdult Vision + Dental

Calibration(2)Product Adjustment

PMPMAdult Vision (1) $4.53 $5.86 1.606 $3.65Adult Dental (1) $17.42 $22.03 1.606 $13.72Total $21.95 $27.89 1.606 $17.36

Base Rate: $369.74Non-EHB Benefits Adjustment: 4.7%

(1) Reflects the PMPM for members who purchase vision and dental coverage.(2) Adjustment for the geographic, age, tobacco use, and plan distribution of the Adult Vision + Dental population. Note that this is distinct from the Calibration factor shown in Appendix 13.1

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EHB for a standard population. Section 1302(d)(1) of the Affordable Care Act requires a bronze

plan to have an AV of 60 percent, a silver plan to have an AV of 70 percent; a gold plan to have

an AV of 80 percent; and a platinum plan to have an AV of 90 percent. Section 1302(d)(3)

further directs the Secretary to establish guidelines for the allowable de minimis variation in AVs

in the level of coverage of a plan.

Currently, §156.140(c) permits a de minimis variation of +/- 2 percentage points.60

In the

proposed rule, we proposed to amend the de minimis range for bronze plans that cover and pay

for at least one major service, other than preventive services (for which certain services already

are required by Federal law to have zero cost sharing), before the deductible to allow a variance

in AV of -2 percentage points and +5 percentage points. We further proposed a list of major

services which may be covered and paid for before deductible in order to make a bronze plan

eligible for the broader de minimis range. The major services proposed were primary care visits,

specialist visits, inpatient hospital services, generic drugs, specialty drugs, preferred branded

drugs, or emergency room services. Additionally, we proposed that the major service covered

before the deductible must apply a reasonable cost-sharing rate to the service to ensure that the

service is affordably covered. Finally, we proposed that a bronze plan that covers at least three

primary care services before the deductible would qualify as having a major service covered

before the deductible.

We proposed this amendment because, without a de minimis adjustment, future

calibrations of the AV Calculator may limit issuers’ flexibility in designing bronze plans.

Further, we believe that bronze plans were not intended to be less generous than catastrophic

60 Under §156.400, the de minimis variation for a silver plan variation means a single percentage point.

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e further proposed a list of major services which may be covered and paid for before deductible in order to make a bronze plan eligible for the broader de minimis range.

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we proposed that the major service covered before the deductible must apply a reasonable cost-sharing rate to the service to ensure that the service is affordably covered.

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plans, which are required to provide at least three primary care visits before the deductible. We

also proposed that bronze plans that are HDHPs be permitted to have the same adjusted de

minimis AV range in order to maintain those plans’ eligibility to become HDHPs that could be

paired with a health savings account while still adhering to the bronze level of AV.

We are finalizing §156.140(c) as proposed, with a technical correction to the regulation

text to change “high deductible high plan” to “high deductible health plan.” We are also

finalizing the 2018 AV Calculator, which provides the option for issuers to calculate AV for a

bronze plan with the broader de minimis range.61

Comment: Many commenters supported our proposal to expand the de minimis range to -

2 and +5 percentage points for certain types of bronze plans. These commenters supported the

increased flexibility in plan design for issuers. Further, these commenters believed that the

proposed changes would generate benefits to consumers by promoting creative plan designs and

plans with more generous benefits than catastrophic plans. Other commenters supported the

proposed requirement that this policy be limited to plans with at least one major service covered

before the deductible in applicable plans and to HDHPs. Finally, some commenters supported

allowing plans which cover at least three primary care visits before the deductible to qualify for

the broader de minimis range. A few commenters did not support this policy because some of

these commenters believed that an expanded de minimis range created the potential of higher

premiums for bronze plans. Some of these commenters believed that these higher premiums may

61 It is the responsibility of the bronze plan issuer to ensure that its bronze plan meets the requirements under this

policy at 45 CFR 156.140(c) if the issuer uses the expanded bronze plan de minimis range in the AV Calculator. For

more information on the operation of this feature in the 2018 AV Calculator, please refer to the 2018 AV Calculator

User Guide and Methodology that are posted at https://www.cms.gov/cciio/resources/regulations-and-

guidance/#Plan Management.

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hurt enrollees in zero cost-sharing plans since these enrollees would see no benefit from changes

in the cost-sharing structure of these plans. Some commenters also expressed concerns that

increasing the de minimis range of bronze plans would make them indistinguishable from silver

plans and inhibit plan design innovation.

Response: We are finalizing the policy as proposed. We believe that this policy provides

a balanced approach by ensuring that a variety of bronze plans can be offered, including HDHPs,

while ensuring that bronze plans can remain at least as generous as catastrophic plans. We are

also finalizing our proposal that a bronze plan with at least three primary care services before the

deductible would qualify for the expanded de minimis range. Issuers are not required to utilize

the expanded bronze de minimis range, and we do not anticipate that this policy will have a

significant impact on average bronze plan premiums. We also note that the purpose of the AV

Calculator is to calculate AV to determine the level of coverage (metal level) of a plan, and it

was not developed for pricing purposes.

Comment: Most commenters supported the list of major services. Some commenters

requested the addition of services, such as habilitative services, rehabilitative services, laboratory

services, and urgent care services. A commenter also requested that SBEs have flexibility in

determining eligible major services. Other comments included a request for assurances that the

policy would only require at least one category of services before the deductible and a request

that HHS require at least one formulary tier to be provided before the deductible. Some

commenters also requested further guidance on our list of major services.

Response: To qualify for the increased de minimis range, the plan must cover at least

one major service before the deductible, with reasonable cost sharing, or meet the requirements

to be a HDHP. We consider a major service to include the category of benefits within that

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he plan must cover at least one major service before the deductible, with reasonable cost sharing, or meet the requirements to be a HDHP

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service type before the deductible. For example, if a Bronze plan is covering specialist visits

before the deductible as the major service to trigger the expanded de minimis range, we would

expect that the before deductible cost sharing would apply to the range of specialist visits that the

issuer covers. We are finalizing the list of major services as proposed. Therefore, the finalized

definition of major services will include primary care visits, specialist visits, inpatient hospital

services, generic drugs, preferred brand drugs, specialty drugs, and emergency room services.

These major services are applicable to a wide variety of enrollees and could have a significant

AV impact. In response to commenters’ requests for a wider list of major services, we

considered adding services, such as urgent care and laboratory outpatient and professional

services to the list of major services. However, these services were omitted due to feasibility

concerns. Based on the claims data used in the 2018 AV Calculator, overall utilization of urgent

care services is relatively low.62

Moreover, given that laboratory services are often accessed in

conjunction, or as the result of, access to other services, such as office visits, which may not be

covered before the deductible, it is unlikely that the majority of enrollees would access

laboratory services before the deductible without having to access other services first. However,

we note that nothing in this policy precludes plans (other than HDHPs) from covering additional

services before the deductible, subject to applicable AV requirements. Also, nothing is in this

policy precludes States from applying other cost-sharing requirements in addition to this policy.

62 Additional information on the consideration of urgent care services in the 2018 AV Calculator is discussed in the

AV Calculator Methodology under the Section entitled “Consideration of Additional Updates Not Made in the 2018

AV Calculator” that is available at: https://www.cms.gov/cciio/resources/regulations-and-guidance/#Plan

Management.

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if a Bronze plan is covering specialist visits before the deductible as the major service to trigger the expanded de minimis range, we would expect that the before deductible cost sharing would apply to the range of specialist visits that the issuer covers.

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We remind issuers that this policy does not exempt issuers from mental health and

substance use disorder parity requirements.63

This includes the rule that a separate deductible

cannot be applied to mental health or substance use disorder benefits and that any deductible

applied to such benefits be no more restrictive than the predominant level of the deductible

applicable to substantially all medical/surgical benefits in a particular category of benefits as

described in 45 CFR 146.136. Section 1302(d)(2)(A) of the Affordable Care Act requires that

AV be determined based a standard population (and without regard to the population the plan

may actually provide benefits to), which is not the population required for mental health and

substance use disorder parity testing. Therefore, the AV Calculator is not intended to

demonstrate parity.

Comment: Some commenters made recommendations for reasonable cost-sharing rates

for services being covered before the deductible. These suggestions included the use of current

cost-sharing review tools, tying reasonable cost sharing to the bronze standardized option rates,

using no more than 50 percent enrollee coinsurance; and requiring copays on the cost sharing for

the major service. Other commenters had recommendations for display and aggregation of these

plans on HealthCare.gov and for education to consumers on these types of plans.

Response: We recognize that States are the primary enforcers of AV policy. Further, we

recognize that services vary in costs by region and that issuers need flexibility in plan design.

However, at a minimum, for the purposes of this bronze plan policy, we believe that any cost-

sharing rate that requires the enrollee to pay for more than 50 percent of the coinsurance (or the

63 See 45 CFR 156.115(a)(3).

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However, at a minimum, for the purposes of this bronze plan policy, we believe that any cost- sharing rate that requires the enrollee to pay for more than 50 percent of the coinsurance (or th

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equivalent copay rate) could be considered an unreasonable cost-sharing rate for the major

service.

(4) Application to Stand-alone Dental Plans Inside the Exchange (§156.150)

In the 2017 Payment Notice, HHS finalized §156.150(a), which establishes a formula to

increase the annual limitation on cost sharing for stand-alone dental plans. Specifically, HHS

finalized that for plan years beginning after 2017, the annual limitation for an SADP for one

covered child would be $350 increased by the percentage increase of the CPI for dental services

for the year 2 years prior to the applicable plan year over the CPI for dental services for 2016;

and, the annual limitation for an SADP for two or more covered children is twice that.

The formula increases the dollar limit for one covered child (currently set at $350) by the

percentage increase of the CPI for dental services for the year 2 years prior to the applicable plan

year over the CPI for 2016. For plan year 2018, the percentage increase of the CPI for dental

services for the year 2 years prior to the applicable plan year would be equal to the CPI for 2016,

resulting in a zero percent increase. Therefore, for plan year 2018, the dental annual limitation

on cost sharing is $350 for one child and $700 for two or more children. For plan years after

2018, we may adjust the annual limitation on cost sharing for stand-alone dental plans in

guidance based on the formula established by regulations at §156.150.

We have also received questions on the percentage of premium properly allocable to

EHB for plans offered or intended to be offered in the individual market through Exchanges.

Under §156.470, issuers of medical and stand-alone dental plan QHPs must provide to

Exchanges an allocation of their QHP premiums to EHBs and other services or benefits.

Because non-pediatric dental benefits (sometimes referred to as dental benefits for “adults,”

meaning individuals age 19 and older) are not EHB under §156.115(d), no portion of the

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equivalent copay rate) could be considered an unreasonable cost-sharing rate for the major service.